RT Journal Article
SR Electronic
T1 Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1225
OP 1232
DO 10.1136/heartjnl-2014-307220
VO 101
IS 15
A1 Jin Sup Park
A1 Kwang Soo Cha
A1 Dae Sung Lee
A1 Donghun Shin
A1 Hye Won Lee
A1 Jun-Hyok Oh
A1 Jeong Su Kim
A1 Jung Hyun Choi
A1 Yong Hyun Park
A1 Han Cheol Lee
A1 June Hong Kim
A1 Kook-Jin Chun
A1 Taek Jong Hong
A1 Myung Ho Jeong
A1 Youngkeun Ahn
A1 Shung Chull Chae
A1 Young Jo Kim
A1 the Korean Acute Myocardial Infarction Registry Investigators
YR 2015
UL http://heart.bmj.com/content/101/15/1225.abstract
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.