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

Abstract

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.

The prognostic impact of revascularization strategy in acute myocardial infarction and cardiogenic shock: Insights from the British Columbia Cardiac Registry

“…The recent analysis from the KAMIR‐NIH (Korea Acute Myocardial Infarction‐National Institute of Health) registry examined CVI versus MVI in 659 patients with STEMI and CS. Contrary to the findings of CULPRIT‐SHOCK and our study, MVI was associated with lower mortality at 1 year (HR = 0.52, 95% CI: 0.38–0.73, P < 0.001) . However, there are a number of differences in study designs and definitions, which make interpretation and comparison difficult.…”

Outcomes of multivessel vs culprit lesion‐only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta‐analysis

“…Complete revascularization, which has recently shown to have better outcomes in hemodynamically stable AMI patients, is thought to be beneficial by improving both hemodynamics and ventricular function . MV‐PCI can also prevent early and late recurrent ischemia in non‐culprit lesions, improve perfusion to watershed areas, promote myocardial salvage and reduce infarct size . However, in our pooled analysis, we did not observe any reduction in short or long‐term mortality with MV‐PCI, compared to CL‐PCI.…”

“…In contrast to CULPRIT‐SHOCK, recently published data from the KAMIR‐NIH registry study showed that MV‐PCI was associated with lower long‐term mortality and repeat revascularization, compared to CL‐PCI in AMI patients with CS . Direct comparisons between these two large studies should be made with caution, given differences in study design, population and inclusion criteria.…”

“…Compared to CULPRIT‐SHOCK, KAMIR‐NIH reported “real world” data reflecting contemporary clinical practice. For example, 24% of patients in the MV‐PCI arm in the CULPRIT‐SHOCK trial underwent an attempt at immediate revascularization of a chronic total occlusion (CTO), which deviates considerably from real world clinical practice in patients with AMI and CS . On the other hand, KAMIR‐NIH was a purely observational study subject to significant selection bias, despite extensive sensitivity analyses.…”

“…On the basis of this trial, the ESC downgraded MV‐PCI in CS from a class II A to a class III B recommendation, in the recently released 2018 ESC guidelines . In contrast to CULPRIT‐SHOCK, recently published real world data from the large‐scale, KAMIR‐NIH registry study showed a significantly lower risk of all‐cause mortality at 1 year with MV‐PCI, compared to CL‐PCI in patients with AMI and CS . Given the inconsistencies in guideline recommendations and conflicting data from clinical studies, we performed an updated meta‐analysis investigating clinical outcomes with MV‐PCI compared to CL‐PCI, in patients with CS complicating AMI.…”