Abstract:

Coronary artery disease (CAD) in older adults presents unique therapeutic challenges due to increased frailty, comorbid conditions, and procedural risk. As life expectancy rises globally, the burden of multivessel disease in elderly patients is growing, yet this group remains underrepresented in major clinical trials. Historically, revascularization strategies in these patients have leaned toward conservative or culprit-lesion-only percutaneous coronary intervention (PCI), driven by concerns over bleeding, renal dysfunction, and procedural complications. However, the FIRE trial—the first randomized clinical trial dedicated exclusively to patients aged 75 years and older with myocardial infarction and multivessel disease—provides pivotal evidence in favor of complete revascularization. This article evaluates the findings of the FIRE trial with support from landmark studies such as the COMPLETE trial, large national registries including BCIS and SCAAR, and contemporary meta-analyses. Results demonstrate that complete PCI in elderly patients significantly reduces the risk of the composite primary outcome, including death, myocardial infarction, stroke, and ischemia-driven revascularization, without a corresponding increase in bleeding or adverse procedural events. These findings support a paradigm shift in the management of elderly patients with multivessel CAD, positioning complete PCI as a superior strategy when guided by clinical judgment and modern interventional techniques.

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