Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction: Three-Year Outcomes of a Randomized Clinical Trial.

However, the durability of this benefit over longer follow-up periods has been questioned by recent studies.

然而，最近的研究对这一益处在更长随访期间的持久性提出了质疑。

Background

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.

确定生理学指导的完全治疗相对于仅针对罪犯血管的治疗，在患有心肌梗死和多血管疾病的老年人中，其益处是否能在3年内持续。

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.

设计、设置和参与者：这项名为“老年多血管疾病心肌梗死患者功能评估（FIRE）”的随机临床试验是由研究者发起的、多中心的、前瞻性的、优效性试验，于2019年7月18日至2021年10月25日在3个国家的34个中心进行。

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.

参与者是患有心肌梗死（无论是ST段还是非ST段抬高型）和多血管疾病的患者，这些患者在成功治疗罪犯病变后住院。

Major exclusion criteria included a nonculprit lesion in the left main coronary artery and unclear identification of the culprit lesion.

主要排除标准包括左主冠状动脉的非罪犯病变和罪犯病变的不明确识别。

Data analysis was performed from March to May 2025.

数据分析工作于2025年3月至5月进行。

Methods

Culprit-only treatment or physiology-guided complete revascularization of nonculprit lesions.

仅针对致病因素的治疗或根据生理学指导的非致病性病变的完全血运重建。

main_outcomes_and_measures

The primary outcome was a patient-oriented composite end point of death, MI, stroke, or ischemia-driven revascularization.

主要结果是患者导向的复合终点，包括死亡、心肌梗死、中风或缺血驱动的血运重建。

Secondary end points included a composite of cardiovascular death or MI and rate of heart failure hospitalizations.

次要终点包括心血管死亡或心肌梗死的复合终点以及心力衰竭住院率。

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%).

在纳入试验的1445名患者中，中位年龄为80岁（四分位数间距77-84岁）；917名患者为男性（占63.5%），528名为女性（占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).

在3年时，主要结果在生理指导的完全血运重建组中发生在165名患者（22.9%），而在仅罪犯组中发生在216名患者（29.8%）（风险比[HR]，0.72；95%置信区间，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).

主要次要结果，即心血管死亡或心肌梗死，在生理指导下的完全血运重建组中显著降低（92名患者[12.8%]），与仅罪犯组相比（132名患者[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).

仅罪犯组的心力衰竭住院率较生理指导下的完全血运重建组更高（143 [19.7%] 对比 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.

在75岁或以上的多支血管病变心肌梗死患者中，生理学指导下的完全血运重建相对于仅处理罪犯病变的治疗在3年时仍显示出持续的益处。

trial_registration

ClinicalTrials.gov Identifier: NCT03772743.

ClinicalTrials.gov 注册号：NCT03772743。