Key result
Multivessel PCI showed no significant difference in short-term (OR 1.17; 95% CI 0.92-1.48) or long-term mortality compared to culprit vessel-only PCI in STEMI patients with cardiogenic shock.
Why the study?
The optimal revascularization strategy in patients with STEMI complicated by cardiogenic shock remains controversial.
Does multivessel percutaneous coronary intervention reduce mortality or improve clinical outcomes in patients with STEMI complicated by cardiogenic shock compared to culprit vessel-only PCI?
Meta-Analysis
Does multivessel percutaneous coronary intervention reduce mortality or improve clinical outcomes in patients with STEMI complicated by cardiogenic shock compared to culprit vessel-only PCI?
Odds Ratio: 1.17 (95% CI 0.92–1.48)
In patients with STEMI complicated by cardiogenic shock, multivessel PCI does not improve mortality compared to culprit-lesion-only PCI and is associated with an increased risk of acute renal failure.
No mortality benefit and higher acute renal failure risk with MV-PCI; reinforces culprit-only approach pending further randomized data.
Background: The optimal revascularization strategy in patients with ST-segment elevation myocardial infarction (STEMI) complicating by cardiogenic shock (CS) remains controversial. This study aims to evaluate the clinical outcomes of multivessel percutaneous coronary intervention (MV-PCI) compared to culprit vessel-only PCI (CO-PCI) for the treatment, only in patients with STEMI with CS. Methods: A comprehensive literature search was conducted. Studies assessed the efficacy outcomes of short (in-hospital or 30 days)/long-term mortality, cardiac death, myocardial reinfarction, repeat revascularization, and safety outcomes of stroke, bleeding, acute renal failure with MV-PCI vs. CO-PCI in patients with STEMI with CS were included. The publication bias and sensitivity analysis were also performed. Results: A total of 15 studies were included in this meta-analysis. There was no significant difference in short- and long-term mortality in patients treated with MV-PCI compared to CO-PCI group [odds ratio (OR) = 1.17; 95% confidence interval (CI), 0.92-1.48; OR = 0.86; 95% CI, 0.58-1.28]. Similarly, there were no significant differences in cardiac death (OR = 0.67; 95% CI, 0.44-1.00), myocardial reinfarction (OR = 1.24; 95% CI, 0.77-2.00), repeat revascularization (OR = 0.75; 95% CI, 0.40-1.42), bleeding (OR = 1.53; 95% CI, 0.53-4.43), or stroke (OR = 1.42; 95% CI, 0.90-2.23) between the two groups. There was a higher risk in acute renal failure (OR = 1.33; 95% CI, 1.04-1.69) in patients treated with MV-PCI when compared with CO-PCI. Conclusion: This meta-analysis suggests that there may be no significant benefit for patients with STEMI complicating CS treated with MV-PCI compared with CO-PCI, and patients are at increased risk of developing acute renal failure after MV-PCI intervention.
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Xiong et al. (2022) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Multivessel percutaneous coronary intervention (MV-PCI) vs. Culprit vessel-only PCI (CO-PCI) was evaluated on Short-term mortality (OR 1.17, 95% CI 0.92-1.48). Multivessel PCI showed no significant difference in short-term (OR 1.17; 95% CI 0.92-1.48) or long-term mortality compared to culprit vessel-only PCI in STEMI patients with cardiogenic shock.
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