• Joo Myung Lee, Tae-Min Rhee, Joo-Yong Hahn, Hyun Kuk Kim, Jonghanne Park, Doyeon Hwang, Ki Hong Choi, Jihoon Kim, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Jin-Ho Choi, Seung-Hyuk Choi, Bon-Kwon Koo, Young Jo Kim, Shung Chull Chae, Myeong Chan Cho, Chong Jin Kim, Hyeon-Cheol Gwon, Ju Han Kim, Hyo-Soo Kim, Myung Ho Jeong, and KAMIR Investigators.
• Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
• J. Am. Coll. Cardiol. 2018 Feb 27; 71 (8): 844-856.

BackgroundRecent 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.ObjectivesThis 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.MethodsAmong 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.ResultsA 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.ConclusionsOf 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.Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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