Immediate multivessel percutaneous coronary intervention versus culprit lesion intervention in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry

Zeymer, Uwe; Hochadel, M.; Thiele, Holger; Andresen, Dietrich; Schühlen, Helmut; Brachmann, Johannes; Elsässer, Albrecht; Gitt, Anselm K.; Zahn, Ralf

doi:10.4244/eijy14m08_04

Cited by 47 publications

(26 citation statements)

References 16 publications

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“…In previous studies, rSS independently predicted mortality in STEMI . Recent CULPRIT‐SHOCK trial showed worse survival in CS in patients treated with multivessel PCI in comparison with revascularization of culprit artery only, and the earlier studies have shown similar results or they have found no survival benefit . In our study, rSS had only modest association with mortality in univariate analysis, but the prognostic value was outweighed by the clinical variables and the risk scores in adjusted analysis.…”

Section: Discussionsupporting

confidence: 41%

“…Median bSS1 at baseline was 22 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). After wiring or thrombectomy, median bSS2 was 19 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), significantly lower than bSS1 (P < 0.01). After revascularization, median rSS was 7 (0-13), lower than bSS1 and bSS2 (both P < 0.01).…”

Section: Baseline Characteristics and Ss Resultsmentioning

confidence: 99%

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Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock

Javanainen

Sans‐Roselló

Harjola

et al. 2018

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 41%

Section: Baseline Characteristics and Ss Resultsmentioning

confidence: 99%

Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock

Javanainen

Sans‐Roselló

Harjola

et al. 2018

Cathet Cardio Intervent

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“…After careful selection, our final analysis included a total of 14 studies. 8,19,22,[25][26][27][28][29][30][31][32][33][34][35][36] Characteristics of individual studies have been described in Table 1. Of the 14 studies, 1 was a RCT, 1 was a post-hoc analysis of RCT data, 5 were prospective and 7 were retrospective.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Outcomes of multivessel vs culprit lesion‐only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta‐analysis

Kundu

Sardar

Kakouros

et al. 2018

Cathet Cardio Intervent

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Objectives This updated meta‐analysis evaluated outcomes with multi‐vessel (MV‐PCI) vs culprit lesion‐only percutaneous coronary intervention (CL‐PCI), in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Background There is considerable debate regarding the optimal revascularization strategy in patients with AMI and CS, particularly regarding management of non‐culprit lesions. Methods Databases were searched for studies comparing MV‐PCI and CL‐PCI in patients with AMI and CS. The primary outcome of interest was short‐term all‐cause mortality. Secondary outcomes included long‐term mortality, repeat revascularization and myocardial reinfarction. Safety outcomes were stroke, acute renal failure and major bleeding. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects models. Results Our meta‐analysis consisting of 14 studies (13 observational, 1 RCT) involving 8,552 patients showed that in comparison to CL‐PCI, MV‐PCI was associated with similar short‐term mortality (OR 1.14; 95% CI 0.9–1.43), as well as similar long‐term mortality (OR 0.94; 95% CI 0.68–1.28). There was no significant difference in the risk of myocardial reinfarction (OR 1.19; 95% CI 0.76–1.86), or repeat revascularization (OR 0.79; 95% CI 0.41–1.55) between the two groups. Compared to CL‐PCI, MV‐PCI was associated with a similar risk of bleeding (OR 1.13; 95% CI 0.91–1.40) and stroke (OR 1.28; 95% CI 0.84–1.96), but a higher risk of developing renal failure (OR 1.32; 95% CI 1.05–1.65). Conclusions Our meta‐analysis suggests that there is a higher risk of renal failure with no additional benefit in efficacy outcomes with MV‐PCI, compared to CL‐PCI in patients with AMI and CS.

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“…In contrast to current guideline recommendation, a registry of cardiogenic shock patients with multivessel coronary artery disease presenting with acute myocardial infarction revealed that MVI‐I was only performed in approximately one quarter of the patients. Furthermore and even more intriguingly, MVI‐I as compared to MVI‐S resulted in increased mortality according to the results of this prospective registry . The prospective, randomized CULPRIT‐SHOCK trial was designed to investigate immediate multivessel PCI in comparison to culprit lesion only PCI with potential staged PCI afterwards .…”

mentioning

confidence: 99%

“…Furthermore and even more intriguingly, MVI-I as compared to MVI-S resulted in increased mortality according to the results of this prospective registry. 4 The prospective, randomized CULPRIT-SHOCK trial was designed to investigate immediate multivessel PCI in comparison to culprit lesion only PCI with potential staged PCI afterwards. 5 The study includes 706 patients to compare two treatment strategies about primary efficacy endpoint of 30-day mortality and renal failure necessitating renal replacement therapy.…”

mentioning

confidence: 99%