Physiology-guided complete revascularization
Physiology-guided complete revascularization has been studied in 4 papers since 2024: 4 trials in people. The newest paper, Oct 25, 2025: “Renal Function-Stratified Comparison of Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and Multivessel Disease”.
4 papers study it9 findingsUpdated
See all 4 papers on physiology-guided complete revascularization
At a glance
The findings reach people, from one lab or study. 1 lab in 2 countries.
“Complete revascularization reduced the primary endpoint in both subgroups (HR: 0.68; 95% CI: 0.52-0.89 for patients with eGFR <60 mL/min/1.73 m2”
None of its findings points the other way.
- 1 lab in 2 countries
- Funders: General Electric and 2 more
- 9 of 9 findings with company ties
- Human trial4
Studies in people
4 studies gave physiology-guided complete revascularization to people and measured what changed.
| What changed | Design | People | Source |
|---|---|---|---|
down: Decreases death, MI, stroke, or ischemia-driven revascularizationHR: 0.68; 95% CI: 0.52-0.89 no change: Has no effect on acute kidney injuryHR: 1.11; 95% CI: 0.87-1.43 | Randomized trial3-year | 1,445 peopleaged ≥75 yearsOlder adults; The oldest old; older MI patients with eGFR <60 mL/min/1.73 m2 | JACC. Cardiovascular interventions, Oct 25, 2025 |
down: Lowers the risk of death, MI, stroke, or ischemia-driven revascularizationHR 0.72, 95% CI 0.58-0.88 down: Lowers the risk of cardiovascular death or MIHR 0.66, 95% CI 0.50-0.88 down: Lowers the risk of heart failure hospitalizationsHR 0.73, 95% CI 0.54-0.97 | Randomized trial3 years | 1,445 peopleBothmedian 80 yearsOlder adults; older patients with MI and multivessel disease | JAMA cardiology, Aug 31, 2025 |
up: Improves angina status7.3 [95% CI, 6.1-8.6] points up: Improves quality of life6.2 [95% CI, 4.4-8.1] points up: Improves physical function1.1 [95% CI, 0.9-1.3] points | Randomized trial1 year | 1,445 peopleBothaged ≥75 yearsOlder adults; The oldest old; myocardial infarction and multivessel disease | Circulation. Cardiovascular quality and outcomes, Jun 18, 2024 |
| Randomized trial | 1,445 people≥75 yearsOlder adults; myocardial infarction and multivessel disease | European journal of preventive cardiology, Mar 7, 2024 |
What did studies of physiology-guided complete revascularization find?
5Studies of physiology-guided complete revascularization measured 5 outcomes; the most studied are acute kidney injury (1 study), death, MI, stroke, or ischemia-driven revascularization (1) and physical function (1).
Acute kidney injury
no changein humans1HR 1.11
1 study
Acute kidney injury
no changein humans1HR 1.11
Physiology-guided complete revascularization showed no clear effect on acute kidney injury in humans (older MI patients with multivessel disease) (HR: 1.11; 95% CI: 0.87-1.43).
“Contrast-associated acute kidney injury occurred in 245 patients (17%), increased progressively across Kidney Disease: Improving Global Outcomes (KDIGO) stages (P < 0.001), and was similar between treatment arms (HR: 1.11; 95% CI: 0.87-1.43).”
Human trialolder MI patients with multivessel disease
JACC. Cardiovascular interventions
Death, MI, stroke, or ischemia-driven revascularization
downin humans1HR 0.68
1 study
Death, MI, stroke, or ischemia-driven revascularization
downin humans1HR 0.68
Physiology-guided complete revascularization decreases death, MI, stroke, or ischemia-driven revascularization in humans (older MI patients with eGFR <60 mL/min/1.73 m2) (HR: 0.68; 95% CI: 0.52-0.89).
“Complete revascularization reduced the primary endpoint in both subgroups (HR: 0.68; 95% CI: 0.52-0.89 for patients with eGFR <60 mL/min/1.73 m2”
Human trialolder MI patients with eGFR <60 mL/min/1.73 m23-year
JACC. Cardiovascular interventions
Physical function
upin humans1
1 study
Physical function
upin humans1
Physiology-guided complete revascularization improves physical function in humans (myocardial infarction and multivessel disease) (1.1 [95% CI, 0.9-1.3] points).
“and physical performance (short physical performance battery, 1.1 [95% CI, 0.9-1.3] points)”
Human trialmyocardial infarction and multivessel disease1 year
Circulation. Cardiovascular quality and outcomes
Quality of life
upin humans1
1 study
Quality of life
upin humans1
Physiology-guided complete revascularization improves quality of life in humans (myocardial infarction and multivessel disease) (6.2 [95% CI, 4.4-8.1] points).
“health-related quality of life (EQ visual analog scale, 6.2 [95% CI, 4.4-8.1] points)”
Human trialmyocardial infarction and multivessel disease1 year
Circulation. Cardiovascular quality and outcomes
Angina status
upin humans1
1 study
Angina status
upin humans1
Physiology-guided complete revascularization improves angina status in humans (myocardial infarction and multivessel disease) (7.3 [95% CI, 6.1-8.6] points).
“Physiology-guided complete revascularization, compared with culprit-only revascularization, was associated with greater improvement in terms of angina status (Seattle Angina Questionnaire summary score, 7.3 [95% CI, 6.1-8.6] points)”
Human trialmyocardial infarction and multivessel disease1 year
Circulation. Cardiovascular quality and outcomes
What is physiology-guided complete revascularization linked with?
4Studies link physiology-guided complete revascularization with 4 measures, most often heart failure hospitalizations (1 study), cardiovascular death or MI (1) and death, MI, stroke, or ischemia-driven revascularization (1).
Heart failure hospitalizations
downin humans1HR 0.73
1 study
Heart failure hospitalizations
downin humans1HR 0.73
Physiology-guided complete revascularization lowers the risk of heart failure hospitalizations in humans (older patients with MI and multivessel disease) (HR 0.73, 95% CI 0.54-0.97).
“Hospitalizations for heart failure were more frequent in the culprit-only group compared with the physiology-guided complete group (143 [19.7%] vs 103 [14.3%]; HR, 0.73; 95% CI, 0.54-0.97; P = .03).”
Human trialolder patients with MI and multivessel disease3 yearsn = 1,445
JAMA cardiology
Cardiovascular death or MI
downin humans1HR 0.66
1 study
Cardiovascular death or MI
downin humans1HR 0.66
Physiology-guided complete revascularization lowers the risk of cardiovascular death or MI in humans (older patients with MI and multivessel disease) (HR 0.66, 95% CI 0.50-0.88).
“cardiovascular death or MI occurred in a significantly lower number of patients in the physiology-guided complete revascularization group (92 patients [12.8%]) compared with the culprit-only group (132 patients [18.2%]; HR, 0.66; 95% CI, 0.50-0.88; P = .004).”
Human trialolder patients with MI and multivessel disease3 yearsn = 1,445
JAMA cardiology
Death, MI, stroke, or ischemia-driven revascularization
downin humans1HR 0.72
1 study
Death, MI, stroke, or ischemia-driven revascularization
downin humans1HR 0.72
Physiology-guided complete revascularization lowers the risk of death, MI, stroke, or ischemia-driven revascularization in humans (older patients with MI and multivessel disease) (HR 0.72, 95% CI 0.58-0.88).
“the primary outcome occurred in 165 patients (22.9%) in the physiology-guided complete revascularization group and 216 patients (29.8%) in the culprit-only group (hazard ratio [HR], 0.72; 95% CI, 0.58-0.88; P = .002).”
Human trialolder patients with MI and multivessel disease3 yearsn = 1,445
JAMA cardiology
Ischaemic adverse events
downin humans1
1 study
Ischaemic adverse events
downin humans1
Physiology-guided complete revascularization lowers the risk of ischaemic adverse events in humans (myocardial infarction and multivessel disease).
“Physiology-guided complete revascularization stands out an effective strategy in reducing ischaemic adverse events, irrespective of pre-admission physical activity status.”
Human trialmyocardial infarction and multivessel diseasen = 1,445
European journal of preventive cardiology