Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
07 Sep 2023
07 Sep 2023
Historique:
medline:
8
9
2023
pubmed:
27
8
2023
entrez:
27
8
2023
Statut:
ppublish
Résumé
The benefit of complete revascularization in older patients (≥75 years of age) with myocardial infarction and multivessel disease remains unclear. In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding. A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P = 0.37). Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. (Funded by Consorzio Futuro in Ricerca and others; FIRE ClinicalTrials.gov number, NCT03772743.).
Sections du résumé
BACKGROUND
BACKGROUND
The benefit of complete revascularization in older patients (≥75 years of age) with myocardial infarction and multivessel disease remains unclear.
METHODS
METHODS
In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding.
RESULTS
RESULTS
A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P = 0.37).
CONCLUSIONS
CONCLUSIONS
Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. (Funded by Consorzio Futuro in Ricerca and others; FIRE ClinicalTrials.gov number, NCT03772743.).
Identifiants
pubmed: 37634150
doi: 10.1056/NEJMoa2300468
doi:
Banques de données
ClinicalTrials.gov
['NCT03772743']
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
889-898Subventions
Organisme : Siemens Healthineers
ID : Unrestricted grant
Investigateurs
Gianluca Campo
(G)
Simone Biscaglia
(S)
Carlo Penzo
(C)
Camilla Matese
(C)
Elisa Venturoli
(E)
Beatrice De Carolis
(B)
Daniele Maio
(D)
Martina Viola
(M)
Elisa Mosele
(E)
Chiara Manzalini
(C)
Giorgio Sacchetta
(G)
Marco Contarini
(M)
Claudia Artale
(C)
Vincenzo Guiducci
(V)
Gianluca Pignatelli
(G)
Iginio Colaiori
(I)
Sergio Musto D'Amore
(S)
Davide Bosi
(D)
Linda Valli
(L)
Rosa De Mola
(R)
Andrea Santarelli
(A)
Mila Menozzi
(M)
Caterina Cavazza
(C)
Luca Fileti
(L)
Andrea Rubboli
(A)
Matteo Aquilina
(M)
Marco Balducelli
(M)
Carolina Moretti
(C)
Ferdinando Varbella
(F)
Enrico Cerrato
(E)
Francesco Tomassini
(F)
Cristina Rolfo
(C)
Alfonso Franzè
(A)
Giulio Piedimonte
(G)
Greca Zanda
(G)
Luca Lo Savio
(L)
Gianni Casella
(G)
Giampiero Nobile
(G)
Alessandro Capecchi
(A)
Valerio Lanzilotti
(V)
Gianmarco Iannopollo
(G)
Roberto Verardi
(R)
Barbara Coutsoumbas
(B)
Flavio Maffia
(F)
Francesco Giannini
(F)
Rossella Ruggiero
(R)
Vincenzo Argentino
(V)
Dino Bonomo
(D)
Diego Milazzo
(D)
Gerlando Pilato
(G)
Giovanni Vaccaro
(G)
Ilenia Di Liberto
(I)
Marco Ruozzi
(M)
Paolo Magnavacchi
(P)
Daniele Iaccarino
(D)
Pietro Landino
(P)
Alfonsina Corbisiero
(A)
Domenico Di Girolamo
(D)
Giuseppe Vadalà
(G)
Giunta Rocco
(G)
Trovato Graziano
(T)
Alberto Menozzi
(A)
Giorgio Caretta
(G)
Marco Arena
(M)
Giuseppe Andò
(G)
Francesco Costa
(F)
Giampiero Vizzari
(G)
Vittorio Virga
(V)
Francesco Saporito
(F)
Michele Pighi
(M)
Andrea Mainardi
(A)
Francesco Della Mora
(F)
Roberto Scarsini
(R)
Flavio Ribichini
(F)
Andrea Picchi
(A)
Alberto Massoni
(A)
Ugo Limbruno
(U)
Andrea Berni
(A)
Stefano Rigattieri
(S)
Marco Barbierato
(M)
Gianpiero D'Amico
(G)
Francesco Gallo
(F)
Maurizio D'Amico
(M)
Alfonso Gambino
(A)
Paolo Calabrò
(P)
Fabio Fimiani
(F)
Elisabetta Moscarella
(E)
Silvio Coletta
(S)
Michele De Benedictis
(M)
Marco Pavani
(M)
Umberto Barbero
(U)
Cinzia Moncalvo
(C)
Javier Escaned Barbosa
(J)
Carlos Vergará
(C)
Angela McInerney
(A)
Hernán Mejia
(H)
Oscar Vedia
(O)
Ana Gomez
(A)
Raul Moreno
(R)
Juan Caro-Codon
(J)
Virginia Fernandez-Figares
(V)
Guillermo Galeote
(G)
Santiago Jimenez-Valero
(S)
Alfonso Jurado-Roman
(A)
María Labrador
(M)
Guiomar Mediavilla
(G)
Sandra Rosillo
(S)
Francisco Fernandez-Aviles
(F)
Enrique Gutierrez Ibañes
(E)
Sandra Vazquez
(S)
Andres Iñiguez Romo
(A)
Guillermo Bastos Fernández
(G)
Alberto Ortiz Sáez
(A)
Jose Antonio Baz Alonso
(JA)
Antonio Alejandro de Miguel Castro
(AA)
Víctor Alfonso Jiménez Díaz
(VA)
Saleta Fernández Barbeira
(S)
Rodrigo Estévez Loureiro
(R)
Rocío González Ferreiro
(R)
Pablo Juan Salvadores
(PJ)
Ana Isabel Ferrero Martínez
(AI)
Sonia Soto Fernández
(S)
María José Rodríguez Pérez
(MJ)
María Pena Martínez
(M)
Fernando Lozano Ruiz-Poveda
(F)
Maria Lopez Lluva
(M)
Jose Abellan
(J)
Ignacio Perez
(I)
José Luis Díez Gil
(JL)
Vicente Jimenez Cruz
(V)
Bernabé López Ledesma
(B)
Raymundo Ocaranza-Sanchez
(R)
Melisa Santás Álvarez
(M)
Jeremias Bayón Lorenzo
(J)
Rubén Vila Abelleira
(R)
Alba Abellás Sequeirós
(A)
Rubén Vila
(R)
Susana Miranda
(S)
Ramiro Trillo Nouche
(R)
Diego Lopez Otero
(D)
Ana Belen Cid Alvarez
(AB)
Juan Carlos Santamaria Pena
(JC)
Diana Pereiro Montes
(D)
Ramón Calviño Santos
(R)
Jose Manuel Vazquez Rodriguez
(JM)
Elena Paz Misiego
(E)
Ignacio J Amat Santos
(IJ)
Alfredo Redondo
(A)
Alberto Campo
(A)
Julio Peral
(J)
Carlos Baladron
(C)
María José Coya
(MJ)
Dariusz Dudek
(D)
Dawid Giszterowicz
(D)
Wojciech Dobrowolski
(W)
Marcin Nosal
(M)
Rafał Marosz
(R)
Piotr Wilusz
(P)
Jarosław Paździerz
(J)
Piotr Żywiec
(P)
Sławomir Szynal
(S)
Stefania Corsi
(S)
Marzia Sivieri
(M)
Matteo Tebaldi
(M)
Javier Escaned
(J)
Emanuele Barbato
(E)
Andres Iniguez Romo
(A)
Ramon Calvino Santos
(R)
José Luis Diez Gil
(JL)
Marco Manfrini
(M)
Carlo Tumscitz
(C)
Rita Pavasini
(R)
Paolo Cimaglia
(P)
Elisa Maietti
(E)
Stefano Volpato
(S)
Anna Zanetti
(A)
Nicola Pasenti
(N)
Greta Carraro
(G)
Giuseppe Biondi Zoccai
(G)
Andrea Erriquez
(A)
Filippo Maria Verardi
(FM)
Serena Caglioni
(S)
Andrea Marrone
(A)
Ennio Scollo
(E)
Antonella Scala
(A)
Matteo Arzenton
(M)
Graziella Pompei
(G)
Nicola Bianchi
(N)
Roberta Campana
(R)
Marta Cocco
(M)
Assunta Di Domenico
(A)
Federico Marchini
(F)
Michele Trichilo
(M)
Federico Sanguettoli
(F)
Davide Scancarello
(D)
Claudio Farina
(C)
Veronica Lodolini
(V)
Sara Fernandez
(S)
Beata Chęcińska-Tokarz
(B)
Commentaires et corrections
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