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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Percutaneous coronary intervention for nonculprit vessels in cardiogenic shock complicating ST-segment elevation

Jeong Hoon Yang1, Joo-Yong Hahn, Pil Sang Song

  • 11Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3Department of Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea. 4Division of Cardiology, Department of Medicine, Chonnam National University, Gwangju, Korea. 5Division of Cardiology, Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 6Division of Cardiology, Department of Medicine, Yeungnam University Hospital, Daegu, Korea.

Critical Care Medicine
|October 10, 2013
PubMed

Insights

Multivessel percutaneous coronary intervention (PCI) did not reduce mortality in ST-segment elevation myocardial infarction patients with cardiogenic shock and multivessel disease. Culprit-only PCI showed similar outcomes during follow-up.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock and multivessel disease presents a complex clinical challenge.
  • Optimal revascularization strategy in these high-risk patients remains debated.

Purpose of the Study:

  • To investigate the clinical impact of multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI.
  • To compare mortality and major adverse cardiac events in STEMI patients with cardiogenic shock and multivessel disease.

Main Methods:

  • A prospective, multicenter, observational study involving 338 patients with STEMI, cardiogenic shock, and multivessel disease.
  • Patients underwent either multivessel PCI or culprit-only PCI during primary PCI.
  • Outcomes including all-cause mortality and major adverse cardiac events were assessed during a median follow-up of 224 days.

Main Results:

  • In-hospital mortality was similar between groups (31.7% vs 24.5%, p=0.247).
  • No significant difference in all-cause mortality during follow-up was observed after adjusting for confounders (35.0% vs 30.6%, adjusted HR 1.06, p=0.831).
  • Rates of major adverse cardiac events and revascularization were also comparable between the two strategies.

Conclusions:

  • Multivessel PCI during primary PCI did not reduce mortality in STEMI patients with cardiogenic shock and multivessel disease.
  • Culprit-only PCI appears to be a viable strategy in this high-risk population, with similar long-term outcomes.
Abstract

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