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Review
. 2017 Nov;10(11):e005582.
doi: 10.1161/CIRCINTERVENTIONS.117.005582.

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

Dhaval Kolte  1 , Partha Sardar  1 , Sahil Khera  1 , Uwe Zeymer  1 , Holger Thiele  1 , Matthias Hochadel  1 , Dragana Radovanovic  1 , Paul Erne  1 , Kristina Hambraeus  1 , Stefan James  1 , Bimmer E Claessen  1 , Jose P S Henriques  1 , Darren Mylotte  1 , Philippe Garot  1 , Wilbert S Aronow  1 , Theophilus Owan  1 , Diwakar Jain  1 , Julio A Panza  1 , William H Frishman  1 , Gregg C Fonarow  1 , Deepak L Bhatt  1 , Herbert D Aronow  1 , J Dawn Abbott  2
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Free article
Review

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

Dhaval Kolte et al. Circ Cardiovasc Interv. 2017 Nov.
Free article

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.

Keywords: cardiogenic shock; complete revascularization; mortality; myocardial infarction; percutaneous coronary intervention; stroke.

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Comment in

  • What Can We Do About Cardiogenic Shock?
    Gershlick AH, Banning AS. Gershlick AH, et al. Circ Cardiovasc Interv. 2017 Nov;10(11):e006020. doi: 10.1161/CIRCINTERVENTIONS.117.006020. Circ Cardiovasc Interv. 2017. PMID: 29146673 No abstract available.

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