Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock

Title
Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock
Author(s)
김영조Kwang Soo Cha[Kwang Soo Cha]Dae Sung Lee[Dae Sung Lee]Jin Sup Park[Jin Sup Park]Hye Won Lee[Hye Won Lee]Jun-Hyok Oh[Jun-Hyok Oh]Jeong Su Kim[Jeong Su Kim]Myung Ho Jeong[Myung Ho Jeong]Kook-Jin Chun[Kook-Jin Chun]Shung Chull Chae[Shung Chull Chae]
Keywords
PERCUTANEOUS CORONARY INTERVENTION; NATIONAL REGISTRY; TEMPORAL TRENDS; CARDIAC-ARREST; PCI REGISTRY; MORTALITY; DISEASE; DEATH
Issue Date
201508
Publisher
BMJ PUBLISHING GROUP
Citation
HEART, v.101, no.15, pp.1225 - 1232
Abstract
Objective The 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. Methods From 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. Results Compared 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). Conclusions This 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.
URI
http://hdl.handle.net/YU.REPOSITORY/31297http://dx.doi.org/10.1136/heartjnl-2014-307220
ISSN
1355-6037
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의과대학 > 내과학교실 > Articles
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