Functional Assessment in Elderly MI Patients With Multivessel Disease - FIRE

Aug 26, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Trial Sponsor:
Consorzio Futuro in Ricerca
Date Presented:
08/26/2023
Date Published:
08/26/2023
Original Posted Date:
08/26/2023
References

Contribution To Literature:

The FIRE trial showed that physiology-guided complete revascularization reduces major adverse cardiac events compared with culprit-only revascularization.

Description:

The goal of the trial was to evaluate multivessel revascularization guided by coronary physiology compared with culprit-only revascularization among elderly patients with acute myocardial infarction (MI) and multivessel coronary artery disease (CAD).

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients with acute MI and multivessel CAD were randomized to multivessel revascularization guided by coronary physiology (n = 720) vs. culprit-only revascularization (n = 725).

  • Total number of enrollees: 1,445
  • Duration of follow-up: 12 months
  • Mean patient age: 80 years
  • Percentage female: 37%
  • Percentage with diabetes: 32%

Inclusion criteria:

  • ≥75 years of age
  • ST-segment elevation myocardial infarction (STEMI) or NSTEMI
  • Successful percutaneous coronary intervention (PCI) of culprit lesion

Exclusion criteria:

  • Unclear culprit lesion
  • Life expectancy <1 year
  • Prior coronary artery bypass grafting (CABG)

Principal Findings:

The primary outcome, death, MI, stroke, or ischemia-driven revascularization at 12 months, was 15.7% in the physiology-guided complete revascularization group vs. 21.0% in the culprit-lesion only group (p < 0.05).

Secondary outcomes:

  • Death or MI: 8.9% in the physiology-guided complete revascularization group vs. 13.5% in the culprit-lesion only group (p < 0.05)
  • Acute kidney injury, stroke, or major bleeding: 22.5% in the physiology-guided complete revascularization group vs. 20.4% in the culprit-lesion only group (p = not significant)

Interpretation:

Among elderly patients with acute MI, physiology-guided complete revascularization improves outcomes compared with culprit-lesion only revascularization. The incidence of acute kidney injury, stroke, or major bleeding was similar between the treatment groups. Multiple trials now support a strategy of complete revascularization among patients with acute coronary syndrome and multivessel CAD.

References:

Biscaglia S, Guiducci V, Escaned J, et al., on behalf of the FIRE Trial Investigators. Complete or Culprit-Only PCI in Older Patients With Myocardial Infarction. N Engl J Med 2023;389:889-98.

Editorial: Mehta SR. Complete Revascularization in Older Patients With Myocardial Infarction. N Engl J Med 2023;389:951-2.

Presented by Dr. Simone Biscaglia at the European Society of Cardiology Congress, Amsterdam, Netherlands, August 26, 2023.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Acute Coronary Syndrome, Coronary Artery Disease, ESC Congress, ESC23, Geriatrics, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention


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