• Jin Sup Park, Kwang Soo Cha, Dae Sung Lee, Donghun Shin, Hye Won Lee, Jun-Hyok Oh, Jeong Su Kim, Jung Hyun Choi, Yong Hyun Park, Han Cheol Lee, June Hong Kim, Kook-Jin Chun, Taek Jong Hong, Myung Ho Jeong, Youngkeun Ahn, Shung Chull Chae, Young Jo Kim, and Korean Acute Myocardial Infarction Registry Investigators.
• Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
• Heart. 2015 Aug 1; 101 (15): 1225-32.

ObjectiveThe value of multivessel revascularisation in cardiogenic shock and multivessel disease (MVD) is still not clear. We compared outcomes following culprit vessel or multivessel revascularisation in patients with ST-elevation myocardial infarction (STEMI), cardiogenic shock and MVD.MethodsFrom 16 620 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in a nationwide, prospective, multicentre registry between January 2006 and December 2012, 510 eligible patients were selected and divided into culprit vessel revascularisation (n=386, 75.7%) and multivessel revascularisation (n=124, 24.3%) groups. The primary outcomes were inhospital mortality and all-cause death during a median 194-day follow-up. A weighted Cox regression model was constructed to determine the HRs and 95% CIs for outcomes in the two groups.ResultsCompared with culprit vessel revascularisation, multivessel revascularisation had a significantly lower adjusted risk of inhospital mortality (9.3% vs 2.4%, HR 0.263, 95% CI 0.149 to 0.462, p<0.001) and all-cause death (13.1% vs 4.8%, HR 0.400, 95% CI 0.264 to 0.606, p<0.001), mainly because of fewer cardiac deaths (9.7% vs 4.8%, HR 0.510, 95% CI 0.329 to 0.790, p=0.002). In addition, multivessel revascularisation significantly decreased the adjusted risk of the composite endpoint of all-cause death, recurrent myocardial infarction and any revascularisation (20.3% vs 18.1%, HR 0.728, 95% CI 0.55 to 0.965, p=0.026).ConclusionsThis study showed that, compared with culprit vessel revascularisation, multivessel revascularisation at the time of primary PCI was associated with better outcomes in patients with STEMI with cardiogenic shock. Our results support the current guidelines regarding revascularisation in these patients.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

32 keywords...

hide…