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Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With
Joo Myung Lee1, Tae-Min Rhee2, Joo-Yong Hahn1
1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Insights
Multivessel percutaneous coronary intervention (PCI) significantly reduces 1-year all-cause death and repeat revascularization in ST-segment elevation myocardial infarction (STEMI) patients with cardiogenic shock. This complete revascularization strategy improves outcomes in this high-risk population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Multivessel percutaneous coronary intervention (PCI) shows benefits over infarct-related artery (IRA)-only PCI in ST-segment elevation myocardial infarction (STEMI) patients.
- Evidence is limited regarding multivessel PCI's impact in STEMI patients experiencing cardiogenic shock.
Purpose of the Study:
- To investigate the prognostic significance of multivessel PCI versus IRA-only PCI.
- To evaluate outcomes in STEMI patients with multivessel disease and cardiogenic shock.
Main Methods:
- Utilized the prospective KAMIR-NIH registry (n=13,104).
- Selected 659 STEMI patients with multivessel disease and cardiogenic shock undergoing primary PCI.
- Compared 1-year all-cause death and patient-oriented composite outcomes between multivessel PCI (n=260) and IRA-only PCI (n=399) groups.
Main Results:
- Multivessel PCI was associated with significantly lower 1-year all-cause death (21.3% vs. 31.7%; HR 0.59) and non-IRA repeat revascularization (6.7% vs. 8.2%; HR 0.39).
- Results remained consistent after multivariable regression, propensity-score matching, and inverse probability weighting.
- Multivessel PCI independently reduced the risk of 1-year all-cause death and patient-oriented composite outcomes.
Conclusions:
- In STEMI patients with multivessel disease and cardiogenic shock, multivessel PCI significantly lowers the risk of death and repeat revascularization.
- Complete revascularization via multivessel PCI appears to be a reasonable strategy for improving outcomes in this critical patient group.
Background:
Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock.
Objectives:
This study investigated the prognostic impact of multivessel PCI in patients with STEMI multivessel disease presenting with cardiogenic shock, using the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction-National Institutes of Health) registry.
Methods:
Among 13,104 consecutive patients enrolled in the KAMIR-NIH registry, we selected patients with STEMI with multivessel disease presenting with cardiogenic shock and who underwent primary PCI. Primary outcome was 1-year all-cause death, and secondary outcomes included patient-oriented composite outcome (a composite of all-cause death, any myocardial infarction, and any repeat revascularization) and its individual components.
Results:
A total of 659 patients were treated by multivessel PCI (n = 260) or IRA-only PCI (n = 399) strategy. The risk of all-cause death and non-IRA repeat revascularization was significantly lower in the multivessel PCI group than in the IRA-only PCI group (21.3% vs. 31.7%; hazard ratio: 0.59; 95% confidence interval: 0.43 to 0.82; p = 0.001; and 6.7% vs. 8.2%; hazard ratio: 0.39; 95% confidence interval: 0.17 to 0.90; p = 0.028, respectively). Results were consistent after multivariable regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. In a multivariable model, multivessel PCI was independently associated with reduced risk of 1-year all-cause death and patient-oriented composite outcome.
Conclusions:
Of patients with STEMI and multivessel disease with cardiogenic shock, multivessel PCI was associated with a significantly lower risk of all-cause death and non-IRA repeat revascularization. Our data suggest that multivessel PCI for complete revascularization is a reasonable strategy to improve outcomes in patients with STEMI with cardiogenic shock.
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