Summary of main studies relating to multivessel PCI in STEMI patients with CGS
| Study (year) | Study type | Main findings |
| Culprit-Shock trial (2017)17 18 | RCT (n=703). | In patients with CGS due to AMI (62% STEMI), the composite endpoint of 30-day death or severe renal failure was lower in the culprit lesion only revascularisation group compared to the group with immediate multivessel PCI (45.9 vs 55.4%, RR: 0.83, 95% CI 0.71 to 0.96, p=0.01). |
| Pasceri et al (2018)14 | Meta-analysis including 11 randomised trials (n=3561). | In STEMI patients with CGS and multivessel disease, a strategy of complete revascularisation had less death or AMI than those with PCI only to the culprit artery (RR: 0.76, 95% CI 0.58 to 0.99, p=0.04). |
| Kolte et al (2017)13 | Meta-analysis including 11 non-randomised studies (n=5850). | Multivessel PCI did not affect short-term or long-term mortality in STEMI patients with CGS compared to culprit artery only PCI (OR: 1.08, 95% CI 0.81 to 1.43, p=0.61) and (OR: 0.84, 95% CI 0.54 to 1.30, p=0.43), respectively. There was a non-significant trend toward higher in-hospital stroke (OR: 1.64, 95% CI 0.98 to 2.72, p=0.06) and renal failure (OR: 1.30, 95% CI 0.98 to 1.72, p=0.06) in the multivessel PCI group compared to the culprit artery only PCI group. |
| KAMIR-NIH Registry (2018)16 | Registry (n=659). | In STEMI patients with CGS and multivessel disease, patients with complete revascularisation had lower all-cause death and non-culprit artery repeat revascularisation than patients with PCI only to the culprit artery (21.3 vs 31.7%, HR: 0.59, 95% CI 0.43 to 0.82, p=0.001). |
| British Columbia Cardiac Registry (2018)15 | Registry (n=649). | In patients with AMI (72% STEMI), CGS and multivessel disease, PCI only to the culprit artery was associated with lower mortality at 30 days (HR=0.63, 95% CI 0.45 to 0.88, p=0.009) and 1 year (HR=0.72, 95% CI 0.54 to 0.96, p=0.027). |
| Euro-Heart Survey PCI Registry (2012)12 | Registry (n=336). | In STEMI patients with CGS, there was a non-statistically significant increase in-hospital mortality with multivessel PCI versus culprit artery only PCI (48.8% vs 37.4%, p=0.07). However, on multivariate analysis, there was no significant difference between groups (OR: 1.28, 95% CI 0.72 to 2.28). |
| Manitoba Cardiogenic Shock Registry (2011)9 | Registry (n=210). | Complete revascularisation during index hospitalisation for STEMI with CGS was an independent predictor of survival to hospital discharge (OR: 2.5, 95% CI 1.1 to 6.2, p=0.03). |
| Mylotte et al (2013)10 | Multicentre prospective observational study (n=266). | STEMI patients with CGS or resuscitated cardiac arrest who underwent multivessel PCI had greater 6-month survival compared to those with culprit artery only PCI (43.9% vs 20.4%, p=0.0017). |
| Park et al (2015)11 | Multicentre retrospective observational study (n=510). | STEMI patients with CGS and multivessel PCI had lower in-hospital mortality than those in the culprit artery only PCI group (2.4% vs 9.3%, HR: 0.26, 95% CI 0.15 to 0.46, p<0.001). |
CGS, cardiogenic shock; PCI, percutaneous coronary intervention; RCT, randomised clinical trial; RR, relative risk; STEMI, ST-segment elevation myocardial infarction.