Complete or Culprit-Only PCI in Older Patients with MI

To the Editor: In their article on the FIRE trial, Biscaglia et al. (Sept. 7 issue) 1 state that the use of physiology-guided complete revascularization resulted in a lower risk of death from cardiovascular or other causes than percutaneous coronary intervention (PCI) alone in older patients (age, ≥75 years) with myocardial infarction and multivessel disease. This reduction in overall mortality was unexpected because such a benefit has not been reported in previous randomized, controlled trials comparing invasive strategies with conservative strategies among older patients with non–ST-segment elevation myocardial infarction (NSTEMI) or comparing complete versus culprit-only revascularization among patients with ST-segment elevation . . .