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J Am Coll Cardiol. 2018 Feb 27;71(8):844-856. doi: 10.1016/j.jacc.2017.12.028.

Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock.

Author information

1
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
2
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
3
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: jyhahn@skku.edu.
4
Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea.
5
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
6
Department of Cardiology, Yeungnam University Medical Center, Daegu, South Korea.
7
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea.
8
Cardiology Division, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea.
9
Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, South Korea.
10
Department of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju, South Korea.

Abstract

BACKGROUND:

Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock.

OBJECTIVES:

This study investigated the prognostic impact of multivessel PCI in patients with STEMI multivessel disease presenting with cardiogenic shock, using the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction-National Institutes of Health) registry.

METHODS:

Among 13,104 consecutive patients enrolled in the KAMIR-NIH registry, we selected patients with STEMI with multivessel disease presenting with cardiogenic shock and who underwent primary PCI. Primary outcome was 1-year all-cause death, and secondary outcomes included patient-oriented composite outcome (a composite of all-cause death, any myocardial infarction, and any repeat revascularization) and its individual components.

RESULTS:

A total of 659 patients were treated by multivessel PCI (n = 260) or IRA-only PCI (n = 399) strategy. The risk of all-cause death and non-IRA repeat revascularization was significantly lower in the multivessel PCI group than in the IRA-only PCI group (21.3% vs. 31.7%; hazard ratio: 0.59; 95% confidence interval: 0.43 to 0.82; p = 0.001; and 6.7% vs. 8.2%; hazard ratio: 0.39; 95% confidence interval: 0.17 to 0.90; p = 0.028, respectively). Results were consistent after multivariable regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. In a multivariable model, multivessel PCI was independently associated with reduced risk of 1-year all-cause death and patient-oriented composite outcome.

CONCLUSIONS:

Of patients with STEMI and multivessel disease with cardiogenic shock, multivessel PCI was associated with a significantly lower risk of all-cause death and non-IRA repeat revascularization. Our data suggest that multivessel PCI for complete revascularization is a reasonable strategy to improve outcomes in patients with STEMI with cardiogenic shock.

KEYWORDS:

ST-segment elevation myocardial infarction; cardiogenic shock; complete revascularization; multivessel disease; outcomes; percutaneous coronary intervention

PMID:
29471935
DOI:
10.1016/j.jacc.2017.12.028
[Indexed for MEDLINE]
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