Comparison of Long-Term Clinical Outcome Between Multivessel Percutaneous Coronary Intervention Versus Infarct-Related Artery-Only Revascularization for Patients With ST-Segment-Elevation Myocardial Infarction With Cardiogenic Shockopen access
- Authors
- Lee, JM[Lee, Joo Myung]; Rhee, TM[Rhee, Tae-Min]; Kim, HK[Kim, Hyun Kuk]; Hwang, D[Hwang, Doyeon]; Lee, SH[Lee, Seung Hun]; Choi, KH[Choi, Ki Hong]; Kim, J[Kim, Jihoon]; Park, TK[Park, Taek Kyu]; Yang, JH[Yang, Jeong Hoon]; Song, YB[Song, Young Bin]; Choi, JH[Choi, Jin-Ho]; Choi, SH[Choi, Seung-Hyuk]; Koo, BK[Koo, Bon-Kwon]; Chae, SC[Chae, Shung Chull]; Cho, MC[Cho, Myeong-Chan]; Kim, CJ[Kim, Chong Jin]; Kim, JH[Kim, Ju Han]; Kim, HS[Kim, Hyo-Soo]; Gwon, HC[Gwon, Hyeon-Cheol]; Jeong, MH[Jeong, Myung Ho]; Hahn, JY[Hahn, Joo-Yong]
- Issue Date
- 17-Dec-2019
- Publisher
- WILEY
- Keywords
- cardiogenic shock; complete revascularization; multivessel disease; outcomes; percutaneous coronary intervention; ST-segment-elevation myocardial infarction
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.8, no.24, pp.e013870
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 8
- Number
- 24
- Start Page
- e013870
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/7879
- DOI
- 10.1161/JAHA.119.013870
- ISSN
- 2047-9980
- Abstract
- Background Data are limited regarding long-term outcomes in patients with ST-segment-elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3-year clinical outcomes of patients with ST-segment-elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct-related artery (IRA)-only PCI. Methods and Results Of 13 104 patients from the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction Registry--National Institutes of Health) registry, we selected 659 patients with ST-segment-elevation myocardial infarction who had concomitant non-IRA stenosis and presented with cardiogenic shock. The primary outcome was all-cause death. Multivessel PCI was performed in 260 patients and IRA-only PCI in 399 patients. At 3 years, patients in the multivessel PCI group had a lower risk of all-cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45-0.94 [P=0.024]), all-cause death or MI (adjusted hazard ratio, 0.59; 95% CI, 0.41-0.84 [P=0.004]), and non-IRA repeat revascularization (adjusted hazard ratio, 0.23; 95% CI, 0.10-0.50 [P<0.001]) than those in the IRA-only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non-IRA repeat revascularization beyond 1 year (log-rank P=0.030 and P=0.017, respectively) than the IRA-only PCI group. Conclusions In patients with ST-segment-elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all-cause death than IRA-only PCI at 3 years, suggesting potential benefit of non-IRA revascularization during the index hospitalization to improve long-term clinical outcomes.
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