Coronary disease & ACSSecondary analysis
Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and High Bleeding Risk
- Prespecified secondary analysis of the FIRE randomised clinical trial
- investigator-initiated
- open-label
- multicentre
- 34 European centres
Authors' conclusion
HBR status is prevalent among older patients with MI, significantly increasing the likelihood of adverse events. Physiology-guided complete revascularization emerges as an effective strategy, in comparison with culprit-only revascularization, for mitigating ischemic adverse events, including cardiovascular death and MI.
Study context
- Population
- Patients ≥75 years with myocardial infarction (MI) and multivessel disease, 34 European centres, July 2019–October 20211,025 (71%) met high bleeding risk (HBR) criteria
- Participants
- 1,445 patients
- Comparison
- Physiology-guided complete revascularization vs culprit-only strategy, by HBR status
- Primary endpoint
- Composite of:
- Death
- MI
- Stroke
- Revascularization
- Follow-up
- 1 year
Primary result
Primary end point in HBR (subgroup)
Hazard ratio
0.73
95% CI 0.55–0.96
Complete revascularization vs Culprit-only
HR 0.73 (95% CI 0.55–0.96)
As reported in the abstract
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Primary end point, HBR vs non-HBR (prognosis) · 1 year | 2.01 (1.47–2.76) | |
| CV death or MI, HBR vs non-HBR (prognosis) | 1.89 (1.26–2.83) | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| BARC types 3 to 5 bleeding, HBR vs non-HBR | 3.28 (1.40–7.64) | |
| 0.10.31310Hazard ratio (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and High Bleeding Risk. JAMA Cardiol. Published 1 June 2024. doi:10.1001/jamacardio.2024.0804
Summarised from the published abstract; every number is checked against it