PT  - JOURNAL ARTICLE
AU  - Jin Sup Park
AU  - Kwang Soo Cha
AU  - Dae Sung Lee
AU  - Donghun Shin
AU  - Hye Won Lee
AU  - Jun-Hyok Oh
AU  - Jeong Su Kim
AU  - Jung Hyun Choi
AU  - Yong Hyun Park
AU  - Han Cheol Lee
AU  - June Hong Kim
AU  - Kook-Jin Chun
AU  - Taek Jong Hong
AU  - Myung Ho Jeong
AU  - Youngkeun Ahn
AU  - Shung Chull Chae
AU  - Young Jo Kim
AU  - the Korean Acute Myocardial Infarction Registry Investigators
TI  - Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock
AID  - 10.1136/heartjnl-2014-307220
DP  - 2015 Aug 01
TA  - Heart
PG  - 1225--1232
VI  - 101
IP  - 15
4099  - http://heart.bmj.com/content/101/15/1225.short
4100  - http://heart.bmj.com/content/101/15/1225.full
SO  - Heart2015 Aug 01; 101
AB  - 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.