Full revascularization proves efficient for older STEMI sufferers in first 4 years

The advantages of full revascularization over culprit-only coronary artery revascularisation have been confirmed in older sufferers with ST-segment elevation myocardial infarction (STEMI) and multivessel illness over the primary 4 years, in response to late-breaking analysis offered in a Scorching Line session at present at ESC Congress 2024.

Treating perpetrator and non-culprit lesions with full revascularisation is the usual remedy for sufferers with STEMI and multivessel illness. Nonetheless, this technique is at the moment underused in older sufferers and the advantages of full revascularisation in contrast with culprit-lesion solely revascularisation stay a subject for debate. We carried out the EARTH-STEMI meta-analysis of information from sufferers aged 75 years or older included in a number of completely different trials and have been in a position to verify the advantages of full revascularization within the first 4 years after the occasion.”

Professor Gianluca Campo, examine presenter from the College Hospital of Ferrara, Ferrara, Italy

Latest trials, such because the COMPLETE trial demonstrated the prevalence of full revascularisation in sufferers with STEMI and multivessel illness. The FIRE trial then confirmed the advantages in older sufferers at 1 12 months however included sufferers with both STEMI or non-STEMI. The person patient-level EARTH-STEMI meta-analysis mixed information on outcomes from older sufferers with STEMI from a number of trials to increase the information base in a bigger group of older sufferers with longer follow-up.

Within the meta-analysis, databases have been systematically searched to establish randomised medical trials evaluating full vs. culprit-only revascularisation in sufferers with MI and multivessel illness. Particular person patient-level information have been collected from the chosen trials for sufferers aged 75 years or older with STEMI. The first endpoint was a composite of dying, myocardial infarction, and ischaemia-driven revascularization. The important thing secondary endpoint was cardiovascular dying and myocardial infarction.

In whole, seven trials have been recognized: COMPLETE, FIRE, FULL REVASC, DANAMI-3-PRIMULTI, COMPARE ACUTE, Hamza et al., and CvLPRIT. Round one-fifth (19%) of the sufferers included in these trials have been aged 75 years or older.

Of the 1,733 sufferers aged 75 years or older included within the meta-analysis, 816 acquired full revascularisation and 917 acquired culprit-only revascularisation. The median age was 79 years outdated and 15% have been aged greater than 85 years. Round one-third have been feminine (34%). Observe-up ranged from 6 months to six.2 years (median 2.5 years), with 20% of sufferers having follow-up information at 4 years.

Full revascularisation was related to a big discount within the major endpoint in contrast with culprit-only revascularisation at 4 years (adjusted hazard ratio [aHR] 0.78; 95% confidence interval [CI] 0.63-0.96; p=0.005). On the longest follow-up, the distinction between the teams was not important (aHR 0.83; 95% CI 0.69-1.01; p=0.063).

On the longest follow-up, there was a 24% discount in cardiovascular dying or myocardial infarction with full vs. culprit-only revascularisation (aHR 0.76; 95% CI 0.58-0.99; p=0.046). There was no distinction between the 2 teams for all-cause mortality (aHR 1.03; 95% CI 0.80-1.32; p=0.818), cardiovascular dying (aHR 0.79; 95% CI 0.56-1.02; p=0.184), or non-cardiovascular dying (aHR 1.40; 95% CI 0.97-2.02; p=0.115). Ischaemia-driven revascularisation was considerably lowered within the full vs. culprit-only group (HR 0.52; 95% CI 0.34-0.85; p=0.002). There have been no important variations between the teams within the security endpoints of stroke, stent thrombosis, main bleeding, or contrast-associated acute kidney harm.

“At the least within the first 4 years, full revascularisation improved outcomes in older sufferers with STEMI and multivessel illness. A limitation is the shortage of sufferers adopted up past 4 years and we await further information from the FIRE trial to offer additional data on longer-term outcomes,” concluded Professor Campo.