Dhaval Kolte1, Partha Sardar1, Sahil Khera1, Uwe Zeymer1, Holger Thiele1, Matthias Hochadel1, Dragana Radovanovic1, Paul Erne1, Kristina Hambraeus1, Stefan James1, Bimmer E Claessen1, Jose P S Henriques1, Darren Mylotte1, Philippe Garot1, Wilbert S Aronow1, Theophilus Owan1, Diwakar Jain1, Julio A Panza1, William H Frishman1, Gregg C Fonarow1, Deepak L Bhatt1, Herbert D Aronow1, J Dawn Abbott2. 1. From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart Center Lübeck, Medical Clinic II, University Hospital Schleswig-Holstein, Germany (H.T.); German Cardiovascular Research Center (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (H.T.); AMIS Plus Data Center, University of Zurich, Switzerland (D.R., P.E.); Department of Cardiology, Falun Hospital, Sweden (K.H.); Department of Medical Sciences, Uppsala University, Sweden (K.H., S.J.); Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (B.E.C., J.P.S.H.); Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, National University of Ireland (D.M.); Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France (P.G.); Department of Medicine, Division of Cardiology, David-Geffen School of Medicine, University of California at Los Angeles (G.C.F.); and Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). 2. From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart Center Lübeck, Medical Clinic II, University Hospital Schleswig-Holstein, Germany (H.T.); German Cardiovascular Research Center (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (H.T.); AMIS Plus Data Center, University of Zurich, Switzerland (D.R., P.E.); Department of Cardiology, Falun Hospital, Sweden (K.H.); Department of Medical Sciences, Uppsala University, Sweden (K.H., S.J.); Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (B.E.C., J.P.S.H.); Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, National University of Ireland (D.M.); Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France (P.G.); Department of Medicine, Division of Cardiology, David-Geffen School of Medicine, University of California at Los Angeles (G.C.F.); and Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). JAbbott@Lifespan.org.
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.
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.
Authors: Ovidiu Chioncel; Sean P Collins; Andrew P Ambrosy; Peter S Pang; Razvan I Radu; Elena-Laura Antohi; Josep Masip; Javed Butler; Vlad Anton Iliescu Journal: Am J Ther Date: 2019 Mar/Apr Impact factor: 2.688
Authors: Mohamed A Omer; Jose E Exaire; Jacob C Jentzer; Yader B Sandoval; Mandeep Singh; Charles R Cagin; Islam Y Elgendy; Tahir Tak Journal: Int J Angiol Date: 2021-02-12
Authors: Kye Taek Ahn; Jin Kyung Oh; Seok Woo Seong; Seon Ah Jin; Jae Hwan Lee; Si Wan Choi; Myung Ho Jeong; Shung Chull Chae; Young Jo Kim; Chong Jin Kim; Hyo Soo Kim; Myeong Chan Cho; Hyeon Cheol Gwon; Jin Ok Jeong; In Whan Seong Journal: Korean Circ J Date: 2020-03 Impact factor: 3.243