https://doi.org/10.55788/fbeafe12
Dr Simone Biscaglia (Ferrara University Hospital, Italy) emphasised that patients older than 75 years of age are poorly represented in trials evaluating revascularisation strategies. “Importantly, the risk of periprocedural complications is higher and prognostically impactful in this population, and the benefit of complete revascularisation has been questioned in older patients with MI” [1,2].
Therefore, the randomised-controlled FIRE trial (NCT03772743) compared a physiology-guided complete revascularisation with a culprit-only revascularisation strategy in patients older than 75 years of age with MI and multivessel disease [3,4]. The included participants (n=1,445) were randomised 1:1 to one of the treatment arms and the primary endpoint was a composite of death, MI, stroke, or ischaemia-driven revascularisation.
At 1 year follow-up, the data showed that participants in the complete-revascularisation arm had a reduced risk of experiencing a primary endpoint event compared with those in the culprit-only arm (15.7% vs 21.0%; HR 0.73; 95% CI 0.57–0.93; P=0.01; see Figure). Similar results were observed for the key secondary endpoint of cardiovascular death or MI (8.9% vs 13.5%; HR 0.64; 95% CI 0.47–0.88; P=0.005). Finally, the composite safety endpoint of contrast-associated acute kidney injury, stroke, or BARC type 3, 4, or 5 bleeding did not show a significant increase in these events in participants in the complete-revascularisation arm compared with those who were randomised to the culprit-only arm (22.5% vs 20.4%; HR 1.11; 95% CI 0.89-1.37; P=0.37).
Figure: Primary endpoint of all-cause death, any MI, stroke, or ischaemia-driven revascularisation [3]
“The results of the FIRE trial demonstrated that physiology-guided complete revascularisation reduces adverse cardiovascular outcomes,” said Prof. Vijay Kunadian (Newcastle University, UK), discussant of this trial. “These results may, however, not be generalisable to all older patients. We should be careful with frail patients, those with many co-morbidities, cognitive impairment, prior coronary artery bypass grafting, or left main disease in particular. Furthermore, we need to await the long-term results of this study and it should be investigated whether angiography-guided percutaneous coronary intervention would result in similar outcomes.”
- Biscaglia S, et al. Am Heart J. 2020;229;100–109.
- Joshi FR, et al. Catheter Cardiovasc Interv. 2021;97:e467-e474.
- Biscaglia S, et al. Functional versus culprit-only revascularization in elderly patients with myocardial infarction and multivessel disease. Hot Line Session 3, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
- Biscaglia S, et al. N Engl J Med 2023; Sept 7. DOI: 10.1056/NEJMoa2300468.
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Table of Contents: ESC 2023
Featured articles
How to manage arterial thrombosis and thromboembolism in COVID-19?
2023 ESC Guidelines & Updates
Heart failure: the 2023 update
Guidelines for Acute Coronary Syndrome
Guidelines for the management of cardiomyopathies
Cardiovascular disease and diabetes: new guidelines
Guidelines for the management of endocarditis
Trial Updates in Heart Failure
Traditional Chinese medicine successful in HFrEF
CRT upgrade benefits patients with HFrEF and an ICD
Catheter ablation saves lives in end-stage HF with AF
Meta-analysis: Does FCM improve clinical outcomes in HF?
HEART-FID: Is intravenous ferric carboxymaltose helpful in HFrEF with iron deficiency?
Natriuresis-guided diuretic therapy to facilitate decongestion in acute HF
DICTATE-AHF: Early dapagliflozin to manage acute HF
STEP-HFpEF: Semaglutide safe and efficacious in HFpEF plus obesity
Key Research on Prevention
Does colchicine prevent perioperative AF and MINS?
Diagnostic tool doubles cardiovascular diagnoses in patients with COPD or diabetes
Inorganic nitrate strongly reduces CIN in high-risk patients undergoing angiography
Finetuning Antiplatelet and Anticoagulation Therapy
Should we use anticoagulation in AHRE to prevent stroke?
Results of FRAIL-AF trial suggest increased bleeding risk with DOACs
The optimal duration of anticoagulation therapy in cancer patients with DVT
DAPT or clopidogrel monotherapy after stenting in high-risk East-Asian patients?
Assets for ACS and PCI Optimisation
Immediate or staged revascularisation in STEMI plus multivessel disease?
Lp(a) and cardiovascular events: which test is the best?
No benefit of extracorporeal life support in MI plus cardiogenic shock
Functional revascularisation outperforms culprit-only strategy in older MI patients
Can aspirin be omitted after PCI in patients with high bleeding risk?
Angiography vs OCT vs IVUS guidance for PCI: a network meta-analysis
OCTOBER trial: OCT-guided PCI improves clinical outcomes in bifurcation lesions
Other
Minimising atrial pacing does not reduce the risk for AF in sinus node disease
ARAMIS: Can anakinra alleviate acute myocarditis?
Expedited transfer to a specialised centre does not improve cardiac arrest outcomes
Acoramidis improves survival and functional status in ATTR-CM
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