Related Experiment Video
Updated: Jan 2, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Comparison of Long-Term Clinical Outcome Between Multivessel Percutaneous Coronary Intervention Versus
Joo Myung Lee1, Tae-Min Rhee2, Hyun Kuk Kim3
1Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea.
Insights
For ST-segment-elevation myocardial infarction patients with cardiogenic shock, multivessel percutaneous coronary intervention (PCI) significantly reduced 3-year all-cause death compared to infarct-related artery (IRA)-only PCI. This suggests broader revascularization improves long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Limited data exist on long-term outcomes for ST-segment-elevation myocardial infarction (STEMI) patients with cardiogenic shock based on revascularization strategy.
- Multivessel disease is common in STEMI patients presenting with cardiogenic shock.
Purpose of the Study:
- To compare 3-year clinical outcomes between multivessel percutaneous coronary intervention (PCI) and infarct-related artery (IRA)-only PCI in STEMI patients with cardiogenic shock and multivessel disease.
Main Methods:
- Retrospective analysis of 659 STEMI patients with cardiogenic shock and non-IRA stenosis from the KAMIR-NIH registry.
- Comparison of all-cause death, all-cause death or myocardial infarction (MI), and non-IRA repeat revascularization between multivessel PCI (n=260) and IRA-only PCI (n=399) groups.
- Statistical analysis included adjusted hazard ratios, propensity score matching, and inverse probability weighting.
Main Results:
- Multivessel PCI was associated with a significantly lower risk of 3-year all-cause death (aHR, 0.65; P=0.024) compared to IRA-only PCI.
- Patients undergoing multivessel PCI also had lower risks of all-cause death or MI (aHR, 0.59; P=0.004) and non-IRA repeat revascularization (aHR, 0.23; P<0.001).
- Landmark analysis beyond 1 year showed reduced recurrent MI and non-IRA repeat revascularization in the multivessel PCI group.
Conclusions:
- In STEMI patients with cardiogenic shock, multivessel PCI is associated with improved 3-year survival compared to IRA-only PCI.
- Revascularization of non-IRA lesions during the index hospitalization may offer significant long-term clinical benefits.
Abstract:
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.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
07:39Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care