{"id":"be705e37ded4","type":"article","url":"https://hartvaat.nl/2025/11/01/fysiologisch-geleide-complete-revascularisatie-bij-ouderen-met-mi-driejaarsdata/","title":"Fysiologisch geleide complete revascularisatie bij ouderen met MI: driejaarsdata","title_en":"Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction: Three-Year Outcomes of a Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["perifeer-vaatlijden"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.3099","source_url":"https://doi.org/10.1001/jamacardio.2025.3099","authors":["Simone Biscaglia","Andrea Erriquez","Vincenzo Guiducci","Javier Escaned","Raul Moreno","Valerio Lanzilotti","Andrea Santarelli","Enrico Cerrato","Giorgio Sacchetta","Alberto Menozzi","Ignacio Amat-Santos","José Luis Díez Gil","Marco Ruozzi","Marco Barbierato","Luca Fileti","Andrea Picchi","Rita Pavasini","Paolo Cimaglia","Iginio Colaiori","Gianni Casella","Mila Menozzi","Caterina Cavazza","Giorgio Caretta","Roberto Scarsini","Gianpiero D'Amico","Giuseppe Vadalà","Gerlando Pilato","Elisabetta Moscarella","Matteo Tebaldi","Gianluca Campo"],"significance":7,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":[],"congress":"","summary_en":"Three-year results confirmed the durable benefit of physiology-guided (FFR/iFR) complete revascularization in older MI patients, providing the longest follow-up data for this approach in the elderly population.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:56Z","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":"Driejaarsdata bevestigden het duurzame voordeel van fysiologisch (FFR/iFR) geleide complete revascularisatie bij ouderen met MI. De benadering optimaliseert de balans tussen complete behandeling en overbehandeling.","abstract_original":"IMPORTANCE: Complete revascularization in older patients with myocardial infarction (MI) and multivessel disease has been shown to reduce cardiovascular death and MI at 1 year. However, the durability of this benefit over longer follow-up periods has been questioned by recent studies. OBJECTIVE: To determine whether the benefit of physiology-guided complete treatment, compared with culprit-only treatment, is sustained at 3 years in older patients with MI and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial, Functional Assessment in Elderly MI Patients With Multivessel Disease (FIRE), was an investigator-initiated, multicenter, prospective, superiority trial conducted at 34 centers across 3 countries from July 18, 2019, to October 25, 2021. Participants were patients with MI (either ST segment or non-ST segment elevated) and multivessel disease who were hospitalized after successful treatment of the culprit lesion. Major exclusion criteria included a nonculprit lesion in the left main coronary artery and unclear identification of the culprit lesion. Data analysis was performed from March to May 2025. INTERVENTIONS: Culprit-only treatment or physiology-guided complete revascularization of nonculprit lesions. MAIN OUTCOMES AND MEASURES: The primary outcome was a patient-oriented composite end point of death, MI, stroke, or ischemia-driven revascularization. Secondary end points included a composite of cardiovascular death or MI and rate of heart failure hospitalizations. RESULTS: Among 1445 patients enrolled in the trial, the median (IQR) age was 80 (77-84) years; 917 patients were male (63.5%) and 528 female (36.5%). At 3 years, the primary outcome occurred in 165 patients (22.9%) in the physiology-guided complete revascularization group and 216 patients (29.8%) in the culprit-only group (hazard ratio [HR], 0.72; 95% CI, 0.58-0.88; P = .002). The key secondary outcome of cardiovascular death or MI occurred in a significantly lower number of patients in the physiology-guided complete revascularization group (92 patients [12.8%]) compared with the culprit-only group (132 patients [18.2%]; HR, 0.66; 95% CI, 0.50-0.88; P = .004). Hospitalizations for heart failure were more frequent in the culprit-only group compared with the physiology-guided complete group (143 [19.7%] vs 103 [14.3%]; HR, 0.73; 95% CI, 0.54-0.97; P = .03). CONCLUSIONS AND RELEVANCE: In patients 75 years or older with MI and multivessel disease, the benefit of physiology-guided complete revascularization over culprit-lesion-only treatment was sustained at 3 years. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03772743."}