Physiology-guided complete revascularization,
does it really help with Reduced death, myocardial infarction, stroke, or ischemia-driven revascularization?
research showsThe grade is B with 72 points. FIRE randomized 1,445 patients aged at least 75 years with myocardial infarction and multivessel disease. At one year, death, myocardial infarction, stroke, or ischemia-driven revascularization occurred in 113/720 (15.7%) with complete revascularization versus 152/725 (21.0%) with culprit-only treatment, HR 0.73 (95% CI 0.57 to 0.93). At three years the result persisted, 22.9% versus 29.8%, HR 0.72 (0.58 to 0.88), but this was follow-up of the same trial.
ads claimThis verdict is restricted to patients aged at least 75 years with myocardial infarction, multivessel disease, and successful culprit-lesion PCI. It cannot be transferred directly to younger patients, stable angina, cardiogenic shock, or anatomy-only complete revascularization.
Useful facts when choosing a product
- Functional significance of nonculprit lesions was assessed by pressure wire or quantitative angiography.
- The one-year and three-year papers report the same FIRE trial.
What the research actually shows
At 34 centers in Italy, Spain, and Poland, 1,445 participants were centrally assigned by a concealed web system to complete revascularization, 720, or culprit-only treatment, 725, and all were included in the primary analysis. The article and NCT03772743 matched for intervention, comparator, and primary endpoint. The nonprofit Consorzio Futuro in Ricerca sponsored the trial but received unrestricted funding from several device companies.
Why this is classified as B (72)
A large hard-outcome trial found sustained event reduction, but it remains one trial with mixed industry funding and possible open-label influence on repeat-revascularization decisions, giving B with 72 points.
Counterpoint. Additional PCI brings contrast, bleeding, vascular, and antiplatelet burdens, so physiology and patient frailty must be considered together.
Rejudgment record. Cross-check applied — Cross-checked the FIRE main report, three-year follow-up, and NCT03772743 for central allocation, primary endpoint, all-randomized analysis, event adjudication, funding, and duplicate reports
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R1 | Single confirmatory trial |
| Independence | I1 | Mixed funding sources |
| Effect size | E+ | Meets the clinically important threshold |
The scoring table and the verdict agree (B).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Reduced death, MI, stroke, or ischemia-driven revascularization at one year | B | Rates were 15.7% versus 21.0%, HR 0.73. |
| Sustained benefit at three years | B | Rates were 22.9% versus 29.8%, HR 0.72, in follow-up of the same trial. |
Cross-check — Codex and Claude
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Study 1 | Open-label randomized trial with blinded event adjudication at 34 centers and three-year follow-up of the same trial | 725 | Nonprofit Consorzio Futuro in Ricerca sponsorship with unrestricted funding from several device companies | Composite of death, myocardial infarction, stroke, or ischemia-driven revascularization | At one year, 113/720 (15.7%) versus 152/725 (21.0%), HR 0.73 (95% CI 0.57 to 0.93); at three years, 165/720 (22.9%) versus 216/725 (29.8%), HR 0.72 (0.58 to 0.88) | Single large hard-outcome trial and same-cohort follow-up |
Receipt — 2 References
All 2 cited sources were verified for existence at the original page (as of 2026-08-15).
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-08-15 · Corrections: none
Cite this verdict
[Chamgap] Physiology-guided complete revascularization x clinical events after MI at age 75 or older — Evidence Grade B·72. 2 cited sources checked. Source: https://chamgap.com/en/verdicts/heart/fire-physiology-guided-complete-revascularization-older-mi/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
What this document does and does not do
Chamgap is an information source. It reports what research has and has not confirmed; it does not tell readers what to take or buy. That decision belongs to readers and, when needed, medical or legal professionals. This verdict reflects literature available up to the search date and may change as new research appears. Nothing here is medical advice.