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Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock
  1. Jin Sup Park1,
  2. Kwang Soo Cha1,2,
  3. Dae Sung Lee1,
  4. Donghun Shin1,
  5. Hye Won Lee1,
  6. Jun-Hyok Oh1,
  7. Jeong Su Kim3,
  8. Jung Hyun Choi1,
  9. Yong Hyun Park3,
  10. Han Cheol Lee1,
  11. June Hong Kim3,
  12. Kook-Jin Chun3,
  13. Taek Jong Hong1,
  14. Myung Ho Jeong4,
  15. Youngkeun Ahn4,
  16. Shung Chull Chae5,
  17. Young Jo Kim6,
  18. the Korean Acute Myocardial Infarction Registry Investigators
  1. 1Department of Cardiology, Pusan National University Hospital, Busan, South Korea
  2. 2Medical Research Institute, Pusan National University Hospital, Busan, South Korea
  3. 3Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
  4. 4Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
  5. 5Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
  6. 6Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea
  1. Correspondence to Professor Kwang Soo Cha, Department of Cardiology and Medical Research Institute, Pusan National University Hospital, 1-10 Ami-dong Seo-gu, Busan 602-739, Republic of Korea; cks{at}pusan.ac.kr

Abstract

Objective The value of multivessel revascularisation in cardiogenic shock and multivessel disease (MVD) is still not clear. We compared outcomes following culprit vessel or multivessel revascularisation in patients with ST-elevation myocardial infarction (STEMI), cardiogenic shock and MVD.

Methods From 16 620 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in a nationwide, prospective, multicentre registry between January 2006 and December 2012, 510 eligible patients were selected and divided into culprit vessel revascularisation (n=386, 75.7%) and multivessel revascularisation (n=124, 24.3%) groups. The primary outcomes were inhospital mortality and all-cause death during a median 194-day follow-up. A weighted Cox regression model was constructed to determine the HRs and 95% CIs for outcomes in the two groups.

Results Compared with culprit vessel revascularisation, multivessel revascularisation had a significantly lower adjusted risk of inhospital mortality (9.3% vs 2.4%, HR 0.263, 95% CI 0.149 to 0.462, p<0.001) and all-cause death (13.1% vs 4.8%, HR 0.400, 95% CI 0.264 to 0.606, p<0.001), mainly because of fewer cardiac deaths (9.7% vs 4.8%, HR 0.510, 95% CI 0.329 to 0.790, p=0.002). In addition, multivessel revascularisation significantly decreased the adjusted risk of the composite endpoint of all-cause death, recurrent myocardial infarction and any revascularisation (20.3% vs 18.1%, HR 0.728, 95% CI 0.55 to 0.965, p=0.026).

Conclusions This study showed that, compared with culprit vessel revascularisation, multivessel revascularisation at the time of primary PCI was associated with better outcomes in patients with STEMI with cardiogenic shock. Our results support the current guidelines regarding revascularisation in these patients.

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