Renal Function-Stratified Comparison of Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and Multivessel Disease
Authors' conclusion
Kidney function remains a strong prognostic factor in older MI patients. Physiology-guided complete revascularization is effective regardless of renal function
Study context
- Population
- Patients aged ≥75 years with myocardial infarction (MI) and multivessel disease662 (45.8 %) estimated glomerular filtration rate (eGFR) <60
- Participants
- 1,445 patients
- Comparison
- Physiology-guided complete vs culprit-only revascularization, by eGFR
- Primary endpoint
- Composite of:
- Death
- MI
- Stroke
- Ischemia-driven revascularization
- Follow-up
- 3 years
Methodological detailssubgroup analysis by renal function
- Subgroup analysis by renal function
Primary result
As reported in the abstract
Primary endpoint by eGFR subgroup
Complete vs Culprit-onlyHazard ratio (95% CI)
eGFR <60 mL/min/1.73 m²
0.68(0.52–0.89)
eGFR ≥60 mL/min/1.73 m²
0.80(0.59–1.10)
Further findings
Primary endpoint by renal function (prognosis) · 3 years
| Comparison | eGFR <60 | eGFR ≥60 | Adjusted HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Lower eGFR | 33.5% | 20.3% | 1.42 (1.15–1.76) | P < 0.001 | |
| 0.512Adjusted hazard ratio (log scale) |
- Primary endpoint by renal function (prognosis): independently associated with higher risk of primary endpoint
Complete vs culprit-only across continuous eGFR range
- HR for complete vs culprit-only revascularization remained stable across the continuous eGFR range
Safety
- Contrast-associated AKI, overall
- 245 patients (17%)
- Increased progressively across KDIGO stages
- P < 0.001
- Similar between treatment arms, HR
- 1.11 (95% CI 0.87-1.43)
Original publication
Renal Function-Stratified Comparison of Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and Multivessel Disease. JACC Cardiovasc Interv. Published 25 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it