Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock
Key result
Multivessel PCI linked to ~41% lower 1-year mortality versus IRA-only PCI in STEMI cardiogenic shock.
- HR 0.59
- 95% CI 0.43 to 0.82
- P=0.001
- n=659
Why the study?
Evidence on the benefit of multivessel PCI over IRA-only PCI in patients with STEMI multivessel disease presenting with cardiogenic shock was limited.
Population
659 patients with STEMI multivessel disease and cardiogenic shock undergoing primary PCI
Comparison
Multivessel PCI vs IRA-only PCI
Design
Nationwide multicenter prospective registry cohort study
Follow-up
1 year
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
HTHolger ThieleInterventional cardiologist, Heart Center Leipzig-University Hospital
“It is just a registry, and registries are always prone to bias and usually lead to misleading results in comparison to a randomized trial such as CULPRIT-SHOCK. This is why we performed CULPRIT-SHOCK.”
JHJoo-Yong HahnInterventional cardiologist, Samsung Medical Center, Seoul
“We respect results from the randomized controlled trial. However, registry data can give us valuable insights, too.”
JPJosé P.S. HenriquesInterventional cardiologist, Academic Medical Center Amsterdam
“Taking into account the low aortic pressure and high left ventricular end-diastolic pressure seen in cardiogenic shock, multivessel PCI may at least theoretically improve myocardial perfusion and hence improve myocardial function, systemic circulation, and recovery from shock.”
Implication
Prospective cohort study shows reduced one-year mortality with multivessel PCI in STEMI patients with cardiogenic shock, indicating a survival benefit from complete revascularization.
Key Points
- To assess the clinical impact of multivessel percutaneous coronary intervention compared with culprit-only intervention in patients with ST-segment elevation myocardial infarction, multivessel disease, and cardiogenic shock.
- Analyzed 659 patients with STEMI, multivessel disease, and cardiogenic shock undergoing primary PCI from the nationwide, multicenter, prospective KAMIR-NIH registry in South Korea.
- Compared outcomes between patients undergoing multivessel PCI (n = 260) and infarct-related artery (IRA)-only PCI (n = 399) using multivariable regression, propensity-score matching, and inverse probability weighting.
- Followed patients for 1 year to evaluate all-cause death, repeat revascularization, and patient-oriented composite outcomes.
- One-year all-cause death was significantly lower in the multivessel PCI cohort than in the IRA-only PCI cohort (21.3% vs. 31.7%; HR: 0.59; 95% CI: 0.43 to 0.82; p = 0.001).
- Non-IRA repeat revascularization occurred significantly less frequently with multivessel PCI compared to IRA-only PCI (6.7% vs. 8.2%; HR: 0.39; 95% CI: 0.17 to 0.90; p = 0.028).
- Multivessel PCI remained independently associated with reduced risks of 1-year all-cause mortality and patient-oriented composite outcomes in adjusted multivariable models.
Study Design
Type
Cohort (n=659)
Multicenter
Yes
PICO
P
Population
659 patients with STEMI, multivessel disease, and cardiogenic shock who underwent primary PCI, followed for 1 year.
E
Exposure / Comparator
Multivessel PCI vs Infarct-related artery (IRA)-only PCI
O
Primary Outcome
1-year all-cause death — HR 0.59 (0.43 to 0.82), p=0.001
Main Result
Hazard Ratio: 0.59 (95% CI 0.43–0.82)
Absolute Event Rate: 21.3% vs 31.7%
p-value: p=0.001
Cite This Study
Lee et al. (2018) conducted a cohort in STEMI with multivessel disease presenting with cardiogenic shock (n=659). Multivessel PCI vs. Infarct-related artery (IRA)-only PCI was evaluated on 1-year all-cause death (HR 0.59, 95% CI 0.43 to 0.82, p=0.001). In patients with STEMI and cardiogenic shock, multivessel PCI was associated with a lower risk of 1-year all-cause death compared to IRA-only PCI (21.3% vs 31.7%; HR 0.59; 95% CI 0.43-0.82; p=0.001).