Related Experiment Video
Updated: Dec 16, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Long-Term Mortality Comparison of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock and
Ruben Vergara1, Elisa Vignini1, Michele Ciabatti1
1Division of Cardiology, Careggi-Hospital, Florence, Italy.
Insights
Multivessel PCI (MV-PCI) in patients with Acute Myocardial Infarction (AMI), multivessel disease (MVD), and cardiogenic shock (CS) is linked to better long-term survival. This approach, treating all significant lesions, improved survival compared to only treating the culprit lesion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Acute Myocardial Infarction (AMI) with multivessel disease (MVD) and cardiogenic shock (CS) presents a complex clinical challenge.
- Primary percutaneous coronary intervention (p-PCI) is the standard treatment, but the optimal revascularization strategy in MVD with CS remains debated.
Purpose of the Study:
- To compare the long-term mortality rates between treating only the culprit lesion (OC-PCI) versus multivessel PCI (MV-PCI) in patients with AMI, MVD, and CS.
- To evaluate the impact of different PCI strategies on survival in a real-world setting.
Main Methods:
- Retrospective analysis of a consecutive patient registry from January 1995 to December 2016.
- Inclusion criteria: patients with AMI, CS, MVD, and successful p-PCI.
- Comparison of 2-year all-cause mortality between OC-PCI and MV-PCI (including immediate or staged procedures).
Main Results:
- Among 292 MVD patients with CS, 159 underwent OC-PCI and 93 underwent MV-PCI.
- The 2-year mortality rate was significantly lower in the MV-PCI group (37.6%) compared to the OC-PCI group (53.5%).
- MV-PCI was independently associated with improved survival (HR 0.54, 95% CI 0.36-0.81).
Conclusions:
- In real-world practice, multivessel PCI is associated with better long-term survival in patients experiencing AMI with MVD and CS.
- This suggests a comprehensive revascularization strategy may be beneficial for high-risk patients.
Objectives:
We sought to determine whether, in a real word context of patients with Acute Myocardial Infarction (AMI), multivessel disease (MVD) and cardiogenic shock (CS), the successful treatment with primary percutaneous coronary intervention (p-PCI) of only culprit lesions (OC-PCI) is associated with better long-term mortality rates than multivessel PCI (MV-PCI) of all significant lesions.
Methods:
From our registry of all consecutive patients admitted for AMI between January 1995 and December 2016 we selected those presenting with CS and MVD successfully treated with p-PCI, and compared those who underwent OC-PCI against MV-PCI, either during the p-PCI (MV-pPCI) or by staged revascularization (Staged-PCI) during hospitalization. The primary endpoint was 2-year all-cause death.
Results:
Among 4210 patients with AMI, 406 (9.6%) presented CS (Killip class IV). A total of 292 patients had MVD. Of them, 252 (86.3%) were successfully treated with p-PCI, 159 patients with OC-PCI and 93 with MV-PCI, either in the same (n = 29) or staged procedure (n = 64). At 2-year follow-up the overall mortality was 47.6%, lower in MV-PCI group (37.6% vs 53.5% in OC-PCI, p = 0.019). Diabetes (HR = 1.50, 1.01-2.22), three vessel disease (HR = 1.49, 1.02-2.17) and basal left ventricular ejection fraction <15% (HR = 3.39, 2.41-6.27) were independent predictors of mortality, while MV-PCI was the only variable associated with improved survival (HR = 0.54, 0.36-0.81).
Conclusions:
In this real world registry of AMI patients with MVD presenting CS, MV-PCI was associated with better long-term survival.
More Related Videos
07:39Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction