Journal of the American Heart Association, 2019. 8(24), e013870-, DOI: https://doi.org/10.1161/JAHA.119.013870

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 Shock

Joo Myung Lee, Tae-Min Rhee; Hyun Kuk Kim; Doyeon Hwang; Seung Hun Lee; Ki Hong Choi; Jihoon Kim; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Jin-Ho Choi; Seung-Hyuk Choi; Bon-Kwon Koo; Shung Chull Chae; Myeong-Chan Cho; Chong Jin Kim; Ju Han Kim; Hyo-Soo Kim; Hyeon-Cheol Gwon; Myung Ho Jeong; Joo-Yong Hahn

Abstract

Background: Data are limited regarding long-term outcomes in patients with ST-segment–elevation myocardial infarction andmultivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the3-year clinical outcomes of patients with ST-segment–elevation myocardial infarction multivessel disease with cardiogenic shockand 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 MyocardialInfarction Registry––National Institutes of Health) registry, we selected 659 patients with ST-segment–elevation myocardial infarctionwho had concomitant non-IRA stenosis and presented with cardiogenic shock. The primary outcome was all-cause death. MultivesselPCI 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 ofall-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 inthe IRA-only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probabilityweighting 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 associatedwith a lower risk of all-cause death than IRA-only PCI at 3 years, suggesting potential benefit of non-IRA revascularization duringthe index hospitalization to improve long-term clinical outcomes. ( J Am Heart Assoc. 2019;8:e013870. DOI:10.1161/JAHA.119.013870e013870.)

• DOI: https://doi.org/10.1161/JAHA.119.013870
• ISBN or ISSN: 2047-9980

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• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.