Functional versus Culprit-only Revascularization in Elderly Patients with Myocardial Infarction and Multivessel Disease (FIRE) trial

Older adults (≥75 years) with myocardial infarction and multivessel disease still suffer an adverse prognosis.

Acute myocardial infarction (AMI) is the most frequent clinical presentation in older adults (≥75 years) who have multivessel disease in 65% of the cases. The rate of death and MI is 3-fold higher in multivessel disease patients if compared to single vessel disease patients, reaching a 15-30% incidence at 1 year.

In the last 10 years, several studies were focused on the treatment of non-culprit lesions. PRAMI, CULPRIT, DANAMI 3 PRIMULTI, COMPARE ACUTE trials showed a significant reduction of revascularizations in complete revascularization arms, but they failed to show a significant impact on death or MI. However, in some studies complete revascularization was angio-based, while a contemporary complete revascularization should be guided by coronary physiology. In addition, mean age was around 60 years and only ST-segment elevated MI (STEMI) patients were included.

However, a culprit lesion is identifiable in more than 90% of NSTEMI patients and the issue on the management of multivessel disease is similar to the one of the STEMI patients. In addition, in older adults, clinical presentation is as NSTEMI in more than 70% of the cases.

Based on this background, it is urgent to generate solid data on the best treatment strategy to apply in older patients with myocardial infarction and multivessel disease.

The “Functional versus Culprit-only Revascularization in Elderly Patients with Myocardial Infarction and Multivessel Disease (FIRE) trial” was designed to test whether a complete revascularization based on coronary physiology may improve prognosis compared to culprit only revascularization in older adults (≥75 years) with myocardial infarction (STEMI or NSTEMI) and multivessel disease.

The primary outcome of interest is a patient-oriented composite endpoint (POCE) of all cause death, any MI, any stroke, any revascularization at 1 year. The trail will include 1400 patients.

If your center is interested in joining the study, please contact US!