Culprit Vessel-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment-Elevation Myocardial Infarction: a Collaborative Meta-Analysis

Authors

Dhaval Kolte
P Sardar
Sahil Khera, New York Medical CollegeFollow
Wilbert S. Aronow, New York Medical CollegeFollow
Diwakar Jain, New York Medical College
Julio Panza, New York Medical CollegeFollow
William Frishman, New York Medical CollegeFollow
J AbbottFollow
Diwakar Jain, New York Medical College
Julio Panza, New York Medical CollegeFollow
William Frishman, New York Medical CollegeFollow
G Fonarow
D Bhatt
H Aronow
J AbbottFollow

Journal Title

Circulation.Cardiovascular Interventions

First Page

e005582

Document Type

Article

Publication Date

11-1-2017

Department

Medicine

Abstract

BACKGROUND: The optimal revascularization strategy in patients with multivessel disease presenting with cardiogenic shock complicating ST-segment-elevation myocardial infarction remains unknown. METHODS AND RESULTS: Databases were searched from 1999 to October 2016. Studies comparing immediate/single-stage multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel-only PCI (CO-PCI) in patients with multivessel disease, ST-segment-elevation myocardial infarction, and cardiogenic shock were included. Primary end point was short-term (in-hospital or 30 days) mortality. Secondary end points included long-term mortality, cardiovascular death, reinfarction, and repeat revascularization. Safety end points were in-hospital stroke, renal failure, and major bleeding. The meta-analysis included 11 nonrandomized studies and 5850 patients (1157 MV-PCI and 4693 CO-PCI). There was no significant difference in short-term mortality with MV-PCI versus CO-PCI (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81-1.43; P=0.61). Similarly, there were no significant differences in long-term mortality (OR, 0.84; 95% CI, 0.54-1.30; P=0.43), cardiovascular death (OR, 0.72; 95% CI, 0.42-1.23; P=0.23), reinfarction (OR, 1.65; 95% CI, 0.84-3.26; P=0.15), or repeat revascularization (OR, 1.13; 95% CI, 0.76-1.69; P=0.54) between the 2 groups. There was a nonsignificant trend toward higher in-hospital stroke (OR, 1.64; 95% CI, 0.98-2.72; P=0.06) and renal failure (OR, 1.30; 95% CI, 0.98-1.72; P=0.06), with no difference in major bleeding (OR, 1.47; 95% CI, 0.39-5.63; P=0.57) with MV-PCI when compared with CO-PCI. CONCLUSIONS: This meta-analysis of nonrandomized studies suggests that in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction, there may be no significant benefit with single-stage MV-PCI compared with CO-PCI. Given the limitations of observational data, randomized trials are needed to determine the role of MV-PCI in this setting.

Comments

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Recommended Citation

Kolte, D., Sardar, P., Khera, S., Aronow, W. S., Jain, D., Panza, J., Frishman, W., Abbott, J., Jain, D., Panza, J., Frishman, W., Fonarow, G., Bhatt, D., Aronow, H., & Abbott, J. (2017). Culprit Vessel-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment-Elevation Myocardial Infarction: a Collaborative Meta-Analysis. Circulation.Cardiovascular Interventions, 10 (11), e005582. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005582