The value of multivessel percutaneous coronary intervention (MV-PCI) in patients with
cardiogenic shock (CS) and multivessel disease (MVD) is still unclear because randomized
controlled trials are missing. Therefore, we sought to evaluate the impact of MV-PCI
on in-hospital outcomes of patients with MVD presenting with CS: 336 patients with
acute myocardial infarction complicated by CS and ≥70% stenoses in ≥2 major epicardial
vessels were included in this analysis of the Euro Heart Survey PCI registry. Patients
undergoing MV-PCI (n = 82, 24%) were compared to those with single-vessel PCI (n =
254, 76%). The rate of 3-vessel disease (60% vs 57%, p = 0.63) was similar in the
2 cohorts. Presentation with resuscitation (48 vs 46%, p = 0.76) and ST-segment elevation
myocardial infarction (83 vs 87%, p = 0.31) was frequent in patients with MV-PCI and
single-vessel PCI. Patients with ventilation were more likely to receive MV-PCI (30%
vs 19%, p = 0.05). There was a tendency toward a higher hospital mortality in patients
with MV-PCI (48.8% vs 37.4%, p = 0.07). After adjustment for confounding variables,
no significant difference for in-hospital mortality (odd ratio [OR] 1.28, 95% confidence
interval [CI] 0.72 to 2.28) could be observed between the 2 groups. Age (OR 1.41,
95% CI 1.13 to 1.77), 3-vessel disease (OR 1.78, 95% CI 1.04 to 3.03), ventilation
(OR 3.01, 95% CI 1.59 to 5.68), and previous resuscitation (OR 2.55, 95% CI 1.48 to
4.39) were independent predictors of hospital death. In conclusion, MV-PCI is currently
used in only 1/4 of patients with CS and MVD. An additional nonculprit PCI was not
associated with a survival benefit in these high risk patients.
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References
- Cardiogenic shock at admission in patients with multivessel disease and acute myocardial infarction treated with percutaneous coronary intervention: related factors.Int J Cardiol. 2007; 123: 29-33
- Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK trial registry.J Am Coll Cardiol. 2000; 36: 1063-1070
- Early revascularization in acute myocardial infarction complicated by cardiogenic shock.N Engl J Med. 1999; 341: 625-634
- Reperfusion therapy in cardiogenic shock complicating acute myocardial infarction.Am Heart J. 1999; 138: S126-S131
- Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial.Circulation. 2005; 112: 1992-2001
- Multivessel coronary artery disease: a key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction.Am Heart J. 1991; 121: 1042-1049
- Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial.J Am Coll Cardiol. 2003; 42: 1373-1379
- Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry.Am Heart J. 2001; 141: 964-970
- Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK trial registry.J Am Coll Cardiol. 2000; 36: 1077-1083
- Leitende Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK).Eur Heart J. 2004; 25: 322-328
- Guidelines for percutaneous coronary interventions.Eur Heart J. 2005; 26: 804-847
- Shock in acute myocardial infarction: the Cape horn for trials?.Eur Heart J. 2010; 31: 1828-1835
- Effect of multivessel coronary disease with or without concurrent chronic total occlusion on one-year mortality in patients treated with primary percutaneous coronary intervention for cardiogenic shock.Am J Cardiol. 2010; 105: 955-959
- Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial.J Am Coll Cardiol. 2003; 42: 1380-1386
- Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK trial registry.J Am Coll Cardiol. 2000; 36: 1084-1090
- Studies on prolonged acute regional ischemia.J Thorac Cardiovasc Surg. 1989; 98: 368-380
- Prognostic implications and predictors of enhanced regional wall motion of the noninfarct zone after thrombolysis and angioplasty therapy of acute myocardial infarction.Circulation. 1989; 80: 245-253
- Thrombosis in ischemic heart disease.Arch Intern Med. 1996; 156: 1382-1394
- C-reactive-protein-associated increase in myocardial infarct size after ischemia/reperfusion.J Pharmacol Exp Ther. 2002; 303: 1007-1013
- Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention.JACC Cardiovasc Interv. 2009; 2: 56-64
- Exaggeration of nonculprit stenosis severity during acute myocardial infarction: implications for immediate multivessel revascularization.J Am Coll Cardiol. 2002; 40: 911-916
Article Info
Publication History
Published online: January 12, 2012
Accepted:
November 18,
2011
Received in revised form:
November 18,
2011
Received:
September 25,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
