Key result
In patients with STEMI and cardiogenic shock, multivessel PCI was associated with a lower risk of all-cause death at 3 years compared to IRA-only PCI (HR 0.65; 95% CI 0.45-0.94; P=0.024).
Why the study?
Data are limited regarding long-term outcomes according to revascularization strategy in patients with STEMI and multivessel disease presenting with cardiogenic shock.
Does multivessel PCI reduce all-cause death in patients with STEMI and cardiogenic shock compared to IRA-only PCI?
Cohort (n=659)
Yes
Does multivessel PCI reduce all-cause death in patients with STEMI and cardiogenic shock compared to IRA-only PCI?
Hazard Ratio: 0.65 (95% CI 0.45–0.94)
p-value: p=0.024
In patients with STEMI and cardiogenic shock, multivessel PCI during the index hospitalization was associated with improved long-term survival compared to IRA-only PCI.
Multivessel PCI may improve survival in STEMI shock; leaves open confirmation in randomized trials.
Background Data are limited regarding long‐term outcomes in patients with ST‐segment–elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3‐year clinical outcomes of patients with ST‐segment‐elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct‐related artery (IRA)–only PCI. Methods and Results Of 13 104 patients from the nationwide, multicenter, prospective KAMIR‐NIH (Korea Acute Myocardial Infarction Registry––National Institutes of Health) registry, we selected 659 patients with ST‐segment‐elevation myocardial infarction who had concomitant non‐IRA stenosis and presented with cardiogenic shock. The primary outcome was all‐cause death. Multivessel PCI was performed in 260 patients and IRA‐only PCI in 399 patients. At 3 years, patients in the multivessel PCI group had a lower risk of all‐cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45–0.94 [ P =0.024]), all‐cause death or MI (adjusted hazard ratio, 0.59; 95% CI, 0.41–0.84 [ P =0.004]), and non‐IRA repeat revascularization (adjusted hazard ratio, 0.23; 95% CI, 0.10–0.50 [ P <0.001]) than those in the IRA‐only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non‐IRA repeat revascularization beyond 1 year (log‐rank P =0.030 and P =0.017, respectively) than the IRA‐only PCI group. Conclusions In patients with ST‐segment‐elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all‐cause death than IRA‐only PCI at 3 years, suggesting potential benefit of non‐IRA revascularization during the index hospitalization to improve long‐term clinical outcomes.
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Lee et al. (2019) conducted a cohort in ST-segment-elevation myocardial infarction with cardiogenic shock (n=659). Multivessel percutaneous coronary intervention vs. Infarct-related artery-only percutaneous coronary intervention was evaluated on all-cause death (HR 0.65, 95% CI 0.45-0.94, p=0.024). In patients with STEMI and cardiogenic shock, multivessel PCI was associated with a lower risk of all-cause death at 3 years compared to IRA-only PCI (HR 0.65; 95% CI 0.45-0.94; P=0.024).
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