ESC 2023 | FIRE-Trial: Physiology Guided Complete Revascularization Benefits Elderly Patients with Myocardial Infarction

Patients over 75 with acute coronary syndrome (ACS) are often badly represented in most significant studies. 

ESC 2023

In this context, the FIRE study looked to determine whether physiology guided complete revascularization is superior to culprit-only revascularization in elderly patients with multivessel disease suffering acute MI. 

The study included SCA patients over 75, hospitalized for both STEMI and NSTEMI, who had received successful PCI of culprit lesion. These patients also presented multivessel disease with at least one lesion in a non-culprit vessel, minimum 2.5 mm in diameter and obstructed between 50% to 99%. 

After treating the culprit lesion, patients were randomized to culprit only treatment or physiology guided complete revascularization (PCI to lesions with positive functional tests). Primary end point was a composite of events including death, MI, stroke or new ischemia driven revascularization within one year. Secondary end point was a combination of cardiovascular death or MI at one year. Individual primary end components were also looked into. 

Read also: ESC 2023 | BUDAPEST CRT Upgrade trial.

The study looked at 1445 patients from 34 centers in Italy, Spain and Poland. Mean patient age was 80, and 36.5% were women. Primary end point was seen in 15.7% of patients undergoing physiology guided revascularization vs. 21% of patients receiving culprit only treatment (RR 0.73, CI 95%: 0.57-0.93; P=0.01). The number needed to treat (NNT) to prevent an event was 19 patients.

Each of this individual components of the primary end point seemed lower with physiology guided PCI, except for stroke, which resulted in reduced mortality (RR 0.64, CI 95%: 0.51-0.96) and NNT 27 patients to prevent death. There were no differences in safety outcomes. 

Dr. Omar Tupayachi

Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.

Source: Presentado en Hot Line Sessions, agosto 26, ESC Congress 2023, Amsterdam.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Spontaneous Left Main Dissection: Clinical Characteristics, management and Outcomes

Courtesy of Dr. Juan Manuel Pérez. Spontaneous left main dissection in an uncommon, and potentially life-threatening, cause of acute MI. The aim of this study,...

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Treatment of Atrial Functional Mitral Regurgitation

Atrial functional mitral regurgitation (aFMR), which results from atrial dilation without significant left ventricular dysfunction, accounts for approximately one-third of mitral regurgitation (MR) cases...

ACURATE Neo2 Underexpansion: Prevalence and Clinical Implications

While transcatheter aortic valve replacement (TAVR) provides durable clinical benefits across a wide range of patients, technical challenges remain that may affect long-term outcomes....

Spontaneous Left Main Dissection: Clinical Characteristics, management and Outcomes

Courtesy of Dr. Juan Manuel Pérez. Spontaneous left main dissection in an uncommon, and potentially life-threatening, cause of acute MI. The aim of this study,...