{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:52:43Z","timestamp":1787507563450,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) showed the superiority of complete revascularization in older patients with myocardial infarction (MI) and multivessel disease. Whether this result applies equally to patients at higher risk of ischemic events due to nonculprit lesion complexity is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Overall, 1445 patients were randomized to culprit-only or complete revascularization. In this prespecified analysis, patients were divided into those with or without at least 1 complex nonculprit lesion. A nonculprit lesion was defined as complex if it met any of the following criteria: angiographic heavy calcification, ostial lesion, true bifurcation lesion involving side-branches &gt;2.5 mm, in-stent restenosis, or long-lesions (estimated stent length &gt;28 mm). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 3 years. The key secondary outcome was a composite of cardiovascular death or MI. The safety outcome included a composite of contrast-associated acute kidney injury, stroke, and Bleeding Academic Research Consortium 3 to 5.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Overall, 641 patients (44%, complex subgroup) had at least 1 complex nonculprit lesion, whereas 804 patients (56%, noncomplex subgroup) did not. After adjustment for potential confounders, patients in the complex subgroup were at higher risk of 3-year cardiovascular death or MI (hazard risk [HR], 1.32 [95% CI, 1.01\u20131.74]), MI (HR, 2.33 [95% CI, 1.44\u20133.78]) and ischemia-driven coronary revascularization (HR, 2.28 [95% CI, 1.46\u20133.56]). Complete revascularization reduced the primary outcome in both the complex (HR, 0.75 [95% CI, 0.56\u20130.99]) and noncomplex (HR, 0.71 [95% CI, 0.53\u20130.95]) subgroups, with no significant interaction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction=0.625). Similarly, no evidence of heterogeneity related to nonculprit lesion complexity was observed for either key secondary or safety end points.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In older patients with MI and multivessel disease, physiology-guided complete revascularization reduced ischemic events, regardless of the complexity of nonculprit lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03772743.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015902","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T08:10:10Z","timestamp":1759479010000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Complete Revascularization in Older Patients With Myocardial Infarction With or Without Complex Nonculprit Lesions"],"prefix":"10.1161","volume":"18","clinical-trial-number":[{"clinical-trial-number":"nct03772743","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1185-1830","authenticated-orcid":true,"given":"Alberto","family":"Sarti","sequence":"first","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Erriquez","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Dal Passo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0701-7329","authenticated-orcid":true,"given":"Gianni","family":"Casella","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Ospedale Maggiore, Bologna, Italy (G. Casella, A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0833-2785","authenticated-orcid":true,"given":"Vincenzo","family":"Guiducci","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S. Maria Nuova Hospital, Italy (V.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7179-1426","authenticated-orcid":true,"given":"Raul","family":"Moreno","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.M.)."},{"name":"Instituto de Investigaci\u00f3n Hospital La Paz (IDIPAZ), University Hospital La Paz, Madrid, Spain (R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-0112","authenticated-orcid":true,"given":"Javier","family":"Escaned","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martin Lagos s\/n, Spain (J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2622-4881","authenticated-orcid":true,"given":"Federico","family":"Marchini","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4280-5232","authenticated-orcid":true,"given":"Marta","family":"Cocco","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-6609","authenticated-orcid":true,"given":"Filippo Maria","family":"Verardi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4169-2977","authenticated-orcid":true,"given":"Stefano","family":"Cl\u00f2","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. Campo, S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-9236","authenticated-orcid":true,"given":"Serena","family":"Caglioni","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Italy (A.S., A.E., B.D.P., F.M., M.C., F.M.V., S. Cl\u00f2, S. Caglioni, J.F., G. 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