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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction With or Without ST-Segment

Marta Cocco1, Gianluca Campo1, Vincenzo Guiducci2

  • 1Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.

Journal of the American College of Cardiology
|September 1, 2024
PubMed

Insights

Complete revascularization in older myocardial infarction (MI) patients, including ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), consistently reduced adverse outcomes compared to culprit-only revascularization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complete revascularization is proven effective for ST-segment elevation myocardial infarction (STEMI).
  • Its effectiveness in non-ST-segment elevation myocardial infarction (NSTEMI) requires further investigation.
  • Older patients with multivessel disease present unique challenges in revascularization strategies.

Purpose of the Study:

  • To compare outcomes of complete revascularization versus culprit-only revascularization in elderly patients with STEMI and NSTEMI.
  • To assess if complete revascularization offers consistent benefits across different MI types in older adults.
  • To evaluate the impact of physiology-guided complete revascularization on major adverse cardiovascular events.

Main Methods:

  • The FIRE trial randomized 1,445 elderly MI patients to culprit-only or physiology-guided complete revascularization.
  • Patients were stratified by STEMI and NSTEMI presentation.
  • The primary outcome was a composite of death, MI, stroke, or revascularization at 1 year; a key secondary outcome was cardiovascular death or MI at 1 year.

Main Results:

  • Physiology-guided complete revascularization significantly reduced the primary outcome in the overall population.
  • In STEMI patients, the primary outcome occurred in 21.1% (culprit-only) vs. 16.2% (complete).
  • In NSTEMI patients, the primary outcome occurred in 20.9% (culprit-only) vs. 15.4% (complete), with no significant interaction between MI type and treatment effect.

Conclusions:

  • Physiology-guided complete revascularization provides consistent benefits for elderly patients with MI, regardless of STEMI or NSTEMI presentation.
  • This strategy is associated with reduced rates of death, MI, stroke, or revascularization at one year.
  • The findings support complete revascularization as a beneficial approach across the MI spectrum in older adults.
Abstract

Keywords:
ST-segment elevation myocardial infarctioncomplete revascularizationmyocardial infarctionnon–ST-segment elevation myocardial infarctionolder patients

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