BACKGROUND: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.

Cardiology Department Maasstad Hospital Rotterdam The Netherlands

Cardiology Unit Azienda Ospedaliero Universitaria di Ferrara Cona Italy

Centre for Heart Valve Innovation St Paul's Hospital University of British Columbia Vancouver Canada

Department of Cardiology Ain Shams University Cairo Egypt

Department of Cardiology Clinical Center of Serbia Belgrade Serbia and Faculty of Medicine University of Belgrade

Department of Cardiology Heart Centre Copenhagen University Hospital Rigshospitalet Denmark

Department of Cardiology Karolinska Institute and Danderyd Hospital Sweden

Department of Cardiology Rigshospitalet University of Copenhagen Denmark

Department of Cardiology Zealand University Hospital Roskilde Denmark

Department of Cardiovascular Sciences University of Leicester and the NIHR Leicester Biomedical Research Centre Glenfield Hospital United Kingdom

Department of Clinical and Molecular Medicine Sapienza University of Rome Italy

Department of Medical Sciences Uppsala University Sweden

Division of Cardiovascular Medicine Gill Heart Institute University of Kentucky Lexington

Faculty of Medicine University of Novi Sad Institute of Cardiovascular Diseases Vojvodina Sremska Kamenica Serbia

Oxford Heart Centre Oxford University Hospitals NHS Trust United Kingdom

Population Health Research Institute Hamilton Health Sciences and McMaster University Canada

Statistics and Education Franciscus Gasthuis en Vlietland Rotterdam The Netherlands

University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic

University of British Columbia Vancouver Canada

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