Acute MI: Complete or Culprit-Only PCI in Older Patients with MI (FIRE trial)

Key points of the FIRE trial:

• The study was a randomized trial of complete revascularization vs. culprit-only revascularization in older patients (≥75 years of age) with myocardial infarction and multi-vessel disease.
• A total of 1445 patients were enrolled.
• 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.
• The results showed that complete revascularization was associated with a lower risk of the primary outcome (15.7% vs. 21.0%, P=0.01) and the key secondary outcome (8.9% vs. 13.5%, P=0.01).
• There was no difference in safety between the two groups.

In conclusion, the study found that complete revascularization is beneficial in older patients with myocardial infarction and multivessel disease. It is associated with a lower risk of death, myocardial infarction, stroke, and any revascularization at 1 year.

Here are some additional details from the study:

• The median age of the patients was 80 years.
• About 36% of the patients were women.
• About 35% of the patients were admitted for ST-segment elevation myocardial infarction.
• The safety outcome did not appear to differ between the groups, but the study was not powered to detect differences in safety.

The study findings support the use of complete revascularization in older patients with myocardial infarction and multivessel disease. However, it is important to note that the study was conducted in a single center and the results may not be generalizable to all patients. Further research is needed to confirm the findings of this study.

Link to the article: DOI: 10.1056/NEJMoa2300468