Joo Myung Lee1, Tae-Min Rhee2, Joo-Yong Hahn3, Hyun Kuk Kim4, Jonghanne Park5, Doyeon Hwang5, Ki Hong Choi1, Jihoon Kim1, Taek Kyu Park1, Jeong Hoon Yang1, Young Bin Song1, Jin-Ho Choi1, Seung-Hyuk Choi1, Bon-Kwon Koo5, Young Jo Kim6, Shung Chull Chae7, Myeong Chan Cho8, Chong Jin Kim9, Hyeon-Cheol Gwon1, Ju Han Kim10, Hyo-Soo Kim5, Myung Ho Jeong10. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. 3. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: jyhahn@skku.edu. 4. Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea. 5. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. 6. Department of Cardiology, Yeungnam University Medical Center, Daegu, South Korea. 7. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea. 8. Cardiology Division, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea. 9. Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, South Korea. 10. Department of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju, South Korea.
Abstract
BACKGROUND: Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock. OBJECTIVES: This study investigated the prognostic impact of multivessel PCI in patients with STEMI multivessel disease presenting with cardiogenic shock, using the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction-National Institutes of Health) registry. METHODS: Among 13,104 consecutive patients enrolled in the KAMIR-NIH registry, we selected patients with STEMI with multivessel disease presenting with cardiogenic shock and who underwent primary PCI. Primary outcome was 1-year all-cause death, and secondary outcomes included patient-oriented composite outcome (a composite of all-cause death, any myocardial infarction, and any repeat revascularization) and its individual components. RESULTS: A total of 659 patients were treated by multivessel PCI (n = 260) or IRA-only PCI (n = 399) strategy. The risk of all-cause death and non-IRA repeat revascularization was significantly lower in the multivessel PCI group than in the IRA-only PCI group (21.3% vs. 31.7%; hazard ratio: 0.59; 95% confidence interval: 0.43 to 0.82; p = 0.001; and 6.7% vs. 8.2%; hazard ratio: 0.39; 95% confidence interval: 0.17 to 0.90; p = 0.028, respectively). Results were consistent after multivariable regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. In a multivariable model, multivessel PCI was independently associated with reduced risk of 1-year all-cause death and patient-oriented composite outcome. CONCLUSIONS: Of patients with STEMI and multivessel disease with cardiogenic shock, multivessel PCI was associated with a significantly lower risk of all-cause death and non-IRA repeat revascularization. Our data suggest that multivessel PCI for complete revascularization is a reasonable strategy to improve outcomes in patients with STEMI with cardiogenic shock.
BACKGROUND: Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock. OBJECTIVES: This study investigated the prognostic impact of multivessel PCI in patients with STEMI multivessel disease presenting with cardiogenic shock, using the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction-National Institutes of Health) registry. METHODS: Among 13,104 consecutive patients enrolled in the KAMIR-NIH registry, we selected patients with STEMI with multivessel disease presenting with cardiogenic shock and who underwent primary PCI. Primary outcome was 1-year all-cause death, and secondary outcomes included patient-oriented composite outcome (a composite of all-cause death, any myocardial infarction, and any repeat revascularization) and its individual components. RESULTS: A total of 659 patients were treated by multivessel PCI (n = 260) or IRA-only PCI (n = 399) strategy. The risk of all-cause death and non-IRA repeat revascularization was significantly lower in the multivessel PCI group than in the IRA-only PCI group (21.3% vs. 31.7%; hazard ratio: 0.59; 95% confidence interval: 0.43 to 0.82; p = 0.001; and 6.7% vs. 8.2%; hazard ratio: 0.39; 95% confidence interval: 0.17 to 0.90; p = 0.028, respectively). Results were consistent after multivariable regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. In a multivariable model, multivessel PCI was independently associated with reduced risk of 1-year all-cause death and patient-oriented composite outcome. CONCLUSIONS: Of patients with STEMI and multivessel disease with cardiogenic shock, multivessel PCI was associated with a significantly lower risk of all-cause death and non-IRA repeat revascularization. Our data suggest that multivessel PCI for complete revascularization is a reasonable strategy to improve outcomes in patients with STEMI with cardiogenic shock.
Authors: Hans Huang; Christopher P Kovach; Sean Bell; Mark Reisman; Gabriel Aldea; James M McCabe; Danny Dvir; Creighton Don Journal: J Interv Cardiol Date: 2019-11-03 Impact factor: 2.279
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
Authors: Andreas Schäfer; Ralf Westenfeld; Jan-Thorben Sieweke; Andreas Zietzer; Julian Wiora; Giulia Masiero; Carolina Sanchez Martinez; Giuseppe Tarantini; Nikos Werner Journal: Front Cardiovasc Med Date: 2021-07-09