Complete Revascularization in Older Patients With Myocardial Infarction With or Without Complex Nonculprit Lesions.

IF 7.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2025-10-03 DOI:10.1161/CIRCINTERVENTIONS.125.015902

Alberto Sarti, Andrea Erriquez, Beatrice Dal Passo, Gianni Casella, Vincenzo Guiducci, Raul Moreno, Javier Escaned, Federico Marchini, Marta Cocco, Filippo Maria Verardi, Stefano Clò, Serena Caglioni, Jacopo Farina, Emanuele Barbato, Giuseppe Vadalà, Caterina Cavazza, Alessandro Capecchi, Francesco Gallo, Gianluca Campo, Simone Biscaglia

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引用次数: 0

Abstract

Background: The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) showed the superiority of complete revascularization in older patients with myocardial infarction (MI) and multivessel disease. Whether this result applies equally to patients at higher risk of ischemic events due to nonculprit lesion complexity is unclear.

Methods: Overall, 1445 patients were randomized to culprit-only or complete revascularization. In this prespecified analysis, patients were divided into those with or without at least 1 complex nonculprit lesion. A nonculprit lesion was defined as complex if it met any of the following criteria: angiographic heavy calcification, ostial lesion, true bifurcation lesion involving side-branches >2.5 mm, in-stent restenosis, or long-lesions (estimated stent length >28 mm). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 3 years. The key secondary outcome was a composite of cardiovascular death or MI. The safety outcome included a composite of contrast-associated acute kidney injury, stroke, and Bleeding Academic Research Consortium 3 to 5.

Results: Overall, 641 patients (44%, complex subgroup) had at least 1 complex nonculprit lesion, whereas 804 patients (56%, noncomplex subgroup) did not. After adjustment for potential confounders, patients in the complex subgroup were at higher risk of 3-year cardiovascular death or MI (hazard risk [HR], 1.32 [95% CI, 1.01-1.74]), MI (HR, 2.33 [95% CI, 1.44-3.78]) and ischemia-driven coronary revascularization (HR, 2.28 [95% CI, 1.46-3.56]). Complete revascularization reduced the primary outcome in both the complex (HR, 0.75 [95% CI, 0.56-0.99]) and noncomplex (HR, 0.71 [95% CI, 0.53-0.95]) subgroups, with no significant interaction (P for interaction=0.625). Similarly, no evidence of heterogeneity related to nonculprit lesion complexity was observed for either key secondary or safety end points.

Conclusions: In older patients with MI and multivessel disease, physiology-guided complete revascularization reduced ischemic events, regardless of the complexity of nonculprit lesions.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03772743.

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老年心肌梗死患者伴或不伴复杂非元凶病变的完全血运重建术

背景：FIRE试验（老年心肌梗死合并多血管疾病患者的功能评估）显示了完全血运重建术在老年心肌梗死合并多血管疾病患者中的优势。该结果是否同样适用于因非罪魁祸首病变复杂性而具有较高缺血性事件风险的患者尚不清楚。方法：1445例患者被随机分为两组，一组为单纯罪犯组，另一组为完全血运重建术组。在这个预先指定的分析中，患者被分为有或没有至少一个复杂的非罪魁祸首病变。非罪魁祸首病变被定义为复杂，如果它符合以下任何标准：血管造影严重钙化，口病变，真分叉病变涉及侧分支>2.5 mm，支架内再狭窄，或长病变（估计支架长度>28 mm）。主要结局包括3年死亡、心肌梗死、中风或血运重建术。关键的次要结局是心血管死亡或心肌梗死的复合结局。安全性结局包括对比剂相关的急性肾损伤、中风和出血的复合结局。结果：总体而言，641例患者（44%，复杂亚组）至少有1个复杂的非罪魁祸首病变，而804例患者（56%，非复杂亚组）没有。在对潜在混杂因素进行校正后，复杂亚组患者3年心血管死亡或心肌梗死（危险风险[HR]， 1.32 [95% CI, 1.01-1.74]）、心肌梗死（HR, 2.33 [95% CI, 1.44-3.78]）和缺血驱动的冠状动脉血运重化术（HR, 2.28 [95% CI, 1.46-3.56]）的风险更高。完全血运重建术降低了复杂亚组（HR, 0.75 [95% CI, 0.56-0.99]）和非复杂亚组（HR, 0.71 [95% CI, 0.53-0.95]）的主要结局，无显著相互作用（相互作用P =0.625）。同样，在关键的次要终点或安全终点，没有观察到与非罪魁祸首病变复杂性相关的异质性证据。结论：在老年心肌梗死和多血管疾病患者中，无论非罪魁祸首病变的复杂性如何，生理引导的完全血运重建术可减少缺血事件。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT03772743。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.