The trial 'should make complete revascularization the standard of care in MI,' and advanced age alone 'should no longer be considered a contraindication,' said an expert.
"This is a remarkable trial that adds substantially to prior studies that examined the topic of complete versus culprit-only revascularization," Deepak L. Bhatt, MD, MPH, Icahn School of Medicine at Mount Sinai, New York City, toldIt shows"quite clearly" that physiology-guided CR is superior to the culprit-only approach in patients with acute MI, said Bhatt, who is also director of Mount Sinai Heart at Mount Sinai Hospital and not connected to FIRE.
"First and foremost, the FIRE trial confirms the benefit of complete revascularization that has been observed in previous trials and provides additional evidence for this approach in older patients," says the author of anThe mortality reduction with CR at 1 years"is particularly notable" and underscores that CR should be considered in all patients with acute MI,"regardless of age," writes Shamir R.
FIRE enrolled patients 75 years or older with MVD, about 64% male, who had been admitted with acute STEMI or NSTEMI at 34 sites in Italy, Spain, and Poland. All underwent successful culprit-lesion PCI using, as"strongly" recommended, the same model of sirolimus-eluting stent, notes the report.
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