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  • Title: 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.
    Author: Kundu A, Sardar P, Kakouros N, Malhotra R, Kolte D, Feldman DN, Abbott JD, Fisher DZ.
    Journal: Catheter Cardiovasc Interv; 2019 Jul 01; 94(1):70-81. PubMed ID: 30593731.
    Abstract:
    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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