Related Experiment Video
Updated: Feb 18, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Culprit Vessel-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock
Dhaval Kolte1, Partha Sardar1, Sahil Khera1
1From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart Center Lübeck, Medical Clinic II, University Hospital Schleswig-Holstein, Germany (H.T.); German Cardiovascular Research Center (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (H.T.); AMIS Plus Data Center, University of Zurich, Switzerland (D.R., P.E.); Department of Cardiology, Falun Hospital, Sweden (K.H.); Department of Medical Sciences, Uppsala University, Sweden (K.H., S.J.); Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (B.E.C., J.P.S.H.); Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, National University of Ireland (D.M.); Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France (P.G.); Department of Medicine, Division of Cardiology, David-Geffen School of Medicine, University of California at Los Angeles (G.C.F.); and Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
Insights
Immediate single-stage multivessel percutaneous coronary intervention (MV-PCI) showed no significant benefit over culprit vessel-only PCI (CO-PCI) for mortality in ST-elevation myocardial infarction with cardiogenic shock. Further randomized trials are needed to confirm these findings.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Optimal revascularization strategy for ST-segment-elevation myocardial infarction (STEMI) with cardiogenic shock and multivessel disease is unclear.
- Current treatment guidelines lack definitive recommendations for this high-risk patient population.
Purpose of the Study:
- To compare the effectiveness and safety of immediate single-stage multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel-only PCI (CO-PCI).
- To evaluate short-term and long-term mortality, cardiovascular outcomes, and safety endpoints in patients with STEMI and cardiogenic shock.
Main Methods:
- A meta-analysis of nonrandomized studies published between 1999 and October 2016.
- Included studies compared MV-PCI with CO-PCI in patients with STEMI, multivessel disease, and cardiogenic shock.
- Primary endpoint was short-term mortality; secondary endpoints included long-term mortality, reinfarction, repeat revascularization, and safety outcomes.
Main Results:
- The meta-analysis included 11 studies with 5850 patients (1157 MV-PCI, 4693 CO-PCI).
- No significant difference was found in short-term mortality (OR, 1.08; P=0.61) or long-term mortality (OR, 0.84; P=0.43) between MV-PCI and CO-PCI.
- Trends towards increased in-hospital stroke and renal failure were observed with MV-PCI, though not statistically significant.
Conclusions:
- This meta-analysis suggests single-stage MV-PCI offers no significant advantage over CO-PCI for patients with STEMI complicated by cardiogenic shock.
- Limitations of observational data necessitate randomized controlled trials to definitively establish the role of MV-PCI in this clinical setting.
Background:
The optimal revascularization strategy in patients with multivessel disease presenting with cardiogenic shock complicating ST-segment-elevation myocardial infarction remains unknown.
Methods And Results:
Databases were searched from 1999 to October 2016. Studies comparing immediate/single-stage multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel-only PCI (CO-PCI) in patients with multivessel disease, ST-segment-elevation myocardial infarction, and cardiogenic shock were included. Primary end point was short-term (in-hospital or 30 days) mortality. Secondary end points included long-term mortality, cardiovascular death, reinfarction, and repeat revascularization. Safety end points were in-hospital stroke, renal failure, and major bleeding. The meta-analysis included 11 nonrandomized studies and 5850 patients (1157 MV-PCI and 4693 CO-PCI). There was no significant difference in short-term mortality with MV-PCI versus CO-PCI (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81-1.43; P=0.61). Similarly, there were no significant differences in long-term mortality (OR, 0.84; 95% CI, 0.54-1.30; P=0.43), cardiovascular death (OR, 0.72; 95% CI, 0.42-1.23; P=0.23), reinfarction (OR, 1.65; 95% CI, 0.84-3.26; P=0.15), or repeat revascularization (OR, 1.13; 95% CI, 0.76-1.69; P=0.54) between the 2 groups. There was a nonsignificant trend toward higher in-hospital stroke (OR, 1.64; 95% CI, 0.98-2.72; P=0.06) and renal failure (OR, 1.30; 95% CI, 0.98-1.72; P=0.06), with no difference in major bleeding (OR, 1.47; 95% CI, 0.39-5.63; P=0.57) with MV-PCI when compared with CO-PCI.
Conclusions:
This meta-analysis of nonrandomized studies suggests that in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction, there may be no significant benefit with single-stage MV-PCI compared with CO-PCI. Given the limitations of observational data, randomized trials are needed to determine the role of MV-PCI in this setting.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiac Catheterization I: Pre-Procedure Overview