{"id":"966872badc5d","type":"article","url":"https://hartvaat.nl/2024/11/05/complete-versus-culprit-only-bij-ouderen-met-stemi-gerandomiseerde-trial/","title":"Complete versus culprit-only bij ouderen met STEMI: gerandomiseerde trial","title_en":"Complete Versus Culprit-Only Revascularization in Older Patients With ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["percutane-coronaire-interventie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.071493","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.071493","authors":["Gianluca Campo","Felix Böhm","Thomas Engstrøm","Pieter C Smits","Islam Y Elgendy","Gerry P McCann","David A Wood","Matteo Serenelli","Stefan James","Dan Eik Høfsten","Bianca M Boxm-de Klerk","Adrian Banning","John A Cairns","Rita Pavasini","Goran Stankovic","Petr Kala","Henning Kelbæk","Emanuele Barbato","Ilija Srdanovic","Mohamed Hamza","Amerjeet S Banning","Simone Biscaglia","Shamir Mehta"],"significance":8,"published":"2024-11-05","source_date":"2024-11-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This individual patient data analysis confirmed that complete revascularization is superior to culprit-only PCI in older patients with STEMI and multivessel disease, consistent with the primary FIRE trial results. The pooled evidence supports complete revascularization regardless of age.","created":"2026-07-03T10:31:17Z","updated":"2026-07-03T13:30:18Z","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":"Gerandomiseerde trial bij ouderen met STEMI en meervatslijden bevestigde dat complete revascularisatie superieur is aan culprit-only PCI. Samen met FIRE vormt dit overtuigend bewijs voor complete revascularisatie ook bij ouderen.","abstract_original":"BACKGROUND: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898."}