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Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock.
- Source :
-
Journal of the American College of Cardiology (JACC) . Feb2018, Vol. 71 Issue 8, p844-856. 13p. - Publication Year :
- 2018
-
Abstract
- <bold>Background: </bold>Recent 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.<bold>Objectives: </bold>This 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.<bold>Methods: </bold>Among 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.<bold>Results: </bold>A 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.<bold>Conclusions: </bold>Of 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *PERCUTANEOUS coronary intervention
*MYOCARDIAL infarction
*MYOCARDIAL infarction treatment
*CARDIOGENIC shock
*PATIENTS
*THERAPEUTICS
*RESEARCH
*RESEARCH methodology
*MEDICAL care
*ACQUISITION of data
*EVALUATION research
*MEDICAL cooperation
*CARDIOVASCULAR system
*COMPARATIVE studies
*CORONARY artery disease
*LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 71
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 128202933
- Full Text :
- https://doi.org/10.1016/j.jacc.2017.12.028