Percutaneous Coronary Intervention for Nonculprit Vessels in Cardiogenic Shock Complicating ST-Segment Elevation Acute Myocardial Infarction

Title
Percutaneous Coronary Intervention for Nonculprit Vessels in Cardiogenic Shock Complicating ST-Segment Elevation Acute Myocardial Infarction
Author(s)
김영조양정훈[양정훈]한주용[한주용]송필상[송필상]송영빈[송영빈]최승혁[최승혁]최진호[최진호]이상훈[이상훈]정명호[정명호]최동주[최동주]
Keywords
EARLY REVASCULARIZATION; MULTIVESSEL DISEASE; PRIMARY ANGIOPLASTY; TEMPORAL TRENDS; TRIAL; REGISTRY; CULPRIT; MORTALITY; SURVIVAL
Issue Date
201401
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
CRITICAL CARE MEDICINE, v.42, no.1, pp.17 - 25
Abstract
Objectives: We investigated the clinical impact of multivessel percutaneous coronary intervention in ST-segment elevation myocardial infarction complicated by cardiogenic shock with multivessel disease. Design: A prospective, multicenter, observational study. Setting: Cardiac ICU of a university hospital. Patients: Between November 2005 and September 2010, 338 patients were selected. Inclusion criteria were as follows: 1) ST-segment elevation myocardial infarction with cardiogenic shock and 2) multivessel disease with successful primary percutaneous coronary intervention for the infarct-related artery. Patients were divided into multivessel percutaneous coronary intervention and culprit-only percutaneous coronary intervention. Interventions: None. Measurements and Main Results: Primary outcome was all-cause mortality. Median follow-up duration was 224 days (interquartile range, 46-383 d). Multivessel percutaneous coronary intervention was performed during the primary percutaneous coronary intervention in 60 patients (17.8%). In-hospital mortality was similar in both groups (multivessel percutaneous coronary intervention vs culprit-only percutaneous coronary intervention, 31.7% vs 24.5%; p = 0.247). All-cause mortality during follow-up was not significantly different between the two groups after adjusting for patient, angiographic, and procedural characteristics as well as propensity scores for receiving multivessel percutaneous coronary intervention (35.0% vs 30.6%; adjusted hazard ratio, 1.06; 95% CI, 0.61-1.86; p = 0.831). There were no significant differences between the groups in rates of major adverse cardiac events (41.7% vs 37.1%; adjusted hazard ratio, 1.03; 95% CI, 0.62-1.71; p = 0.908) and any revascularization (6.7% vs 4.7%; adjusted hazard ratio, 1.88; 95% CI, 0.51-6.89; p = 0.344). Conclusions: Multivessel percutaneous coronary intervention could not reduce the prevalence of mortality in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction and multivessel disease during primary percutaneous coronary intervention.
URI
http://hdl.handle.net/YU.REPOSITORY/33511http://dx.doi.org/10.1097/CCM.0b013e3182a2701d
ISSN
0090-3493
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의과대학 > 내과학교실 > Articles
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