{"id":"066d6106b4c2","type":"article","url":"https://hartvaat.nl/2023/09/07/fire-complete-revascularisatie-bij-ouderen-75-jaar-met-mi-nejm/","title":"FIRE: complete revascularisatie bij ouderen ≥75 jaar met MI — NEJM","title_en":"Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2300468","source_url":"https://doi.org/10.1056/NEJMoa2300468","authors":["Simone Biscaglia","Vincenzo Guiducci","Javier Escaned","Raul Moreno","Valerio Lanzilotti","Andrea Santarelli","Enrico Cerrato","Giorgio Sacchetta","Alfonso Jurado-Roman","Alberto Menozzi","Ignacio Amat Santos","José Luis Díez Gil","Marco Ruozzi","Marco Barbierato","Luca Fileti","Andrea Picchi","Veronica Lodolini","Giuseppe Biondi-Zoccai","Elisa Maietti","Rita Pavasini","Paolo Cimaglia","Carlo Tumscitz","Andrea Erriquez","Carlo Penzo","Iginio Colaiori","Gianluca Pignatelli","Gianni Casella","Gianmarco Iannopollo","Mila Menozzi","Ferdinando Varbella","Giorgio Caretta","Dariusz Dudek","Emanuele Barbato","Matteo Tebaldi","Gianluca Campo"],"significance":9,"published":"2023-09-07","source_date":"2023-09-07","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The FIRE trial demonstrated that complete revascularization reduced cardiovascular death or MI compared with culprit-only PCI in patients aged 75 or older with MI and multivessel disease. The results extended the benefit of complete revascularization to the elderly population previously excluded from major trials.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De FIRE-trial in de NEJM toonde dat complete revascularisatie ook bij ouderen ≥75 jaar met MI en meervatslijden superieur was aan alleen culprit-PCI. CV-events en mortaliteit daalden significant. Dit beëindigt de onzekerheid over complete revascularisatie bij ouderen.","abstract_original":"BACKGROUND: The benefit of complete revascularization in older patients (≥75 years of age) with myocardial infarction and multivessel disease remains unclear. 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: 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: 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.)."}