Consistent benefit of physiology-guided complete revascularization across the spectrum of frailty in older patients with myocardial infarction: a prespecified analysis of the FIRE trial.
Background The number of older patients admitted with myocardial infarction (MI) is increasing, and their clinical profiles range from very fit to frail and functionally impaired. Objectives To evaluate whether the benefits of complete revascularization are consistent across subpopulations of older...
| Publicado en: | Age & Ageing Vol. 55; no. 4; pp. 1 - 8 |
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| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Apr2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=193500076&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193500076 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Apr2026 vid: 55 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 193500076 10.1093/ageing/afag078 ppf: 1 ppct: 7 formats: tig: atl: Consistent benefit of physiology-guided complete revascularization across the spectrum of frailty in older patients with myocardial infarction: a prespecified analysis of the FIRE trial. aug: au: Passo, Beatrice Dal Tonet, Elisabetta Lanzilotti, Valerio Menozzi, Mila Scarsini, Roberto Picchi, Andrea Andò, Giuseppe Sarti, Alberto Farina, Jacopo Cantone, Anna affil: Cardiology Unit, Azienda, Ospedaliero Universitaria di Ferrara, Cona (FE), Emilia Romagna, Italy Cardiology Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy Cardiovascular Department, Ospedale degli Infermi di Rimini, Rimini, Emilia-Romagna, Italy Cardiology Unit, University Hospital of Verona, Verona, Veneto, Italy Cardiovascular Department, Misericordia Hospital, Grosseto, Tuscany, Italy Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicily, Italy su: Myocardial infarction risk factors Myocardial infarction Risk assessment Pearson correlation (Statistics) Research funding Frail elderly Treatment effectiveness Mann Whitney U Test Chi-squared test Descriptive statistics Myocardial revascularization Kaplan-Meier estimator Geriatric assessment Research Data analysis software Confidence intervals Proportional hazards models sug: subj: Myocardial infarction risk factors Myocardial infarction Risk assessment Pearson correlation (Statistics) Research funding Frail elderly Treatment effectiveness Mann Whitney U Test Chi-squared test Descriptive statistics Myocardial revascularization Kaplan-Meier estimator Geriatric assessment Research Data analysis software Confidence intervals Proportional hazards models keyword: aging clinical frailty scale (CFS) copyrightHolder:British Geriatrics Society copyrightYear:2026 fire - disasters fire - physical phenomenon frail elderly frailty https://dx.doi.org/10.1093/ageing/afag078 inLanguage:en myocardial infarction older adult older people physiology physiology guided revascularization publisher:Oxford University Press revascularization sameAs:https://pubmed.ncbi.nlm.nih.gov/41965249/ aging clinical frailty scale (CFS) copyrightHolder:British Geriatrics Society copyrightYear:2026 fire - disasters fire - physical phenomenon frail elderly frailty https://dx.doi.org/10.1093/ageing/afag078 inLanguage:en myocardial infarction older adult older people physiology physiology guided revascularization publisher:Oxford University Press revascularization sameAs:https://pubmed.ncbi.nlm.nih.gov/41965249/ ab: Background The number of older patients admitted with myocardial infarction (MI) is increasing, and their clinical profiles range from very fit to frail and functionally impaired. Objectives To evaluate whether the benefits of complete revascularization are consistent across subpopulations of older MI patients stratified by the Clinical Frailty Scale (CFS). Methods In the FIRE trial, 1445 patients aged ≥75 years with MI and multivessel disease were randomized to either complete or culprit-only revascularization. Overall, 1010 patients (70%) were stratified according to CFS (scores 1–3 non-frail, 4 pre-frail, 5–9 frail). The primary endpoint was a 3-year composite of death, MI, stroke, or ischemia-driven revascularization. Results Of the stratified cohort, 523 (52%) were non-frail, 304 (30%) pre-frail, and 183 (18%) frail. Increasing frailty was significantly associated with a higher risk of the primary endpoint (HR 1.62, 95% CI 1.19–2.20; P = .002). Complete revascularization reduced the primary endpoint with no significant interaction between revascularization strategy and CFS category (p for interaction = 0.769). The benefit of complete versus culprit-only revascularization remained consistent across the full range of CFS scores. Similar findings were observed for secondary endpoints, and no significant interaction emerged for safety outcomes. Conclusions Frailty, as assessed by the CFS, was independently associated with adverse outcomes. Complete revascularization was effective regardless of frailty status and should be considered in all older MI patients with multivessel disease undergoing an invasive strategy. Trial Registration ClinicalTrials.gov Identifier: NCT03772743. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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