- Question
- In patients aged 75 years or older with myocardial infarction and multivessel disease, does physiology-guided complete revascularization improve clinical outcomes compared with treating only the culprit lesion?
- Design
- Multicenter, randomized, open-label (unmasked) trial of 1445 patients assigned to complete revascularization or culprit-only treatment; follow-up of 1 year.
- Population
- Patients aged 75 years or older (median age 80 years) with myocardial infarction and multivessel disease undergoing PCI of the culprit lesion; 35.2% were admitted with ST-segment elevation myocardial infarction and 36.5% were women.
- Intervention
- Revascularization of functionally significant nonculprit lesions, identified by pressure wire or angiography, in addition to culprit-lesion PCI.
- Control
- Culprit-lesion PCI only, with no further revascularization of other lesions.
- Primary outcome
- Composite of death, myocardial infarction, stroke, or any revascularization at 1 year.
- Results
- The primary outcome occurred in 113 patients (15.7%) with complete revascularization and in 152 (21.0%) with culprit-only treatment (HR 0.73; 95% CI 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 8.9% vs. 13.5% (HR 0.64; 95% CI 0.47 to 0.88).
- Safety
- The safety outcome (contrast-associated acute kidney injury, stroke, or bleeding) did not appear to differ between groups (22.5% vs. 20.4%; P = 0.37).
- Conclusion
- In patients aged 75 years or older with myocardial infarction and multivessel disease, physiology-guided complete revascularization lowered the 1-year risk of the clinical composite compared with culprit-only PCI.
- Why it matters
- It provided evidence specific to an older population, often underrepresented in trials, supporting consideration of physiology-guided complete revascularization rather than limiting treatment to the culprit lesion.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026