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Cardiogenic shock complicating acute myocardial infarction and multivessel disease: revascularization strategy according to ischemic territory.

Authors
Hong Choi, KiLee, Sang YoonPark, Taek KyuLee, Joo MyungSong, Young BinHahn, Joo-YongChoi, Seung-HyukAhn, Chul-MinYu, Cheol WoongHyun Park, IkJang, Woo JinKim, Hyun-JoongBae, Jang-WhanKwon, Sung UkLee, Hyun-JongLee, Wang SooJeong, Jin-OkPark, Sang-DonKang, Tae-SooGwon, Hyeon-CheolYang, Jeong Hoon
Issue Date
May-2024
Keywords
Acute myocardial infarction; Cardiogenic shock; Ischemic territory; Multivessel disease; Percutaneous coronary intervention
Citation
Revista espanola de cardiologia (English ed.)
Journal Title
Revista espanola de cardiologia (English ed.)
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/74265
DOI
10.1016/j.rec.2024.05.005
ISSN
1885-5857
1885-5857
Abstract
OBJECTIVE: The association of revascularization strategy with clinical outcomes according to the ischemic territory of nonculprit lesion has not been documented in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This study aimed to compare outcomes between culprit-only and immediate multivessel percutaneous coronary intervention (PCI) according to ischemic territory in patients with AMI-CS. METHODS: A total of 536 patients with AMI-CS and multivessel disease from the SMART-RESCUE registry were categorized according to ischemic territory (nonculprit left main/proximal left anterior descending artery [LM/pLAD] vs culprit LM/pLAD vs no LM/pLAD). The primary outcome was a patient-oriented composite endpoint (POCE) consisting of all-cause death, myocardial infarction, rehospitalization due to heart failure, or repeat revascularization at 1 year. RESULTS: Among the total population, 108 patients had nonculprit LM/pLAD, 228 patients had culprit LM/pLAD, and 200 patients had no LM/pLAD, with the risk of POCE being higher in patients with large ischemic territory lesions (53.6% vs 53.4% vs 39.6%; P = .02). Multivessel PCI was associated with a significantly lower risk of POCE compared with culprit-only PCI in patients with nonculprit LM/pLAD (40.7% vs 66.9%; HR, 0.52; 95%CI, 0.29-0.91; P = .02), but not in those with culprit LM/pLAD (P = .46) or no LM/pLAD (P = .47). A significant interaction existed between revascularization strategy and large nonculprit ischemic territory (P = .03). CONCLUSIONS: Large ischemic territory involvement was associated with worse clinical outcomes in patients with AMI-CS and multivessel disease. Immediate multivessel PCI might improve clinical outcomes in patients with a large nonculprit ischemic burden. Copyright © 2024. Published by Elsevier España, S.L.U.
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