Percutaneous Coronary Intervention in Multivessel Disease and Infarct-Related Cardiogenic Shock: A DanGer Shock...

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Optimal percutaneous coronary intervention (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock and multivessel disease is unclear.
• Multivessel disease is common in STEMI patients experiencing cardiogenic shock.

Purpose of the Study:

• To investigate the association between PCI strategy and clinical outcomes.
• To compare immediate multivessel PCI versus culprit-only PCI in STEMI-related cardiogenic shock with multivessel disease.

Main Methods:

• Exploratory substudy of the DanGer Shock multicenter trial.
• Included STEMI patients with cardiogenic shock and multivessel disease (excluding comatose patients).
• Analyzed outcomes based on as-treated PCI strategy: immediate multivessel PCI or culprit-only PCI.

Main Results:

• Of 221 patients with multivessel disease, 118 (53%) underwent culprit-only PCI and 103 (47%) underwent immediate multivessel PCI.
• All-cause mortality at 180 days was 61% in the culprit-only group versus 50% in the immediate multivessel PCI group.
• Immediate multivessel PCI was associated with a 60% lower odds of all-cause mortality (adjusted OR: 0.40).

Conclusions:

• Immediate multivessel PCI in STEMI-related cardiogenic shock with multivessel disease is associated with significantly lower all-cause mortality.
• Culprit-only PCI strategy showed higher mortality rates in this high-risk patient population.
• Further research may confirm immediate multivessel PCI as a preferred strategy.