Author + information
- Krishnaraj Rathod1,
- Sudheer Koganti1,
- Ajay Jain1,
- Charles Knight1,
- Anthony Mathur1,
- Alexander Sirker1,
- Constantinos O’Mahony1,
- Andrew Wragg1 and
- Daniel Jones1
Despite advances in technology patients with Cardiogenic Shock (CS) presenting with ST-segment myocardial infarction (STEMI) have a poor prognosis with high mortality rates. A large proportion of these patients have multi-vessel coronary artery disease, the treatment of which is still unclear. We aimed to assess the current trends in management of CS patients with multi-vessel disease (MVD), particularly looking at the incidence and outcomes of multi-vessel (MV) intervention compared to culprit vessel (CV) only intervention in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI) for STEMI.
We undertook an observational cohort study of 21,210 STEMI patients treated between 2005 and 2015 at the 8 Heart Attack Centres in London, UK. Patients’ details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. 1058 patients presented with CS and MVD. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (IQR range: 2.2-5.8 years).
497 patients underwent multi-vessel intervention during primary PCI for CS with stable rates over time. Those patients undergoing MV intervention were more likely to be male, hypertensive and more likely to have poor LV function compared to the CV intervention group. Although crude, in hospital MACE rates were similar (40.8% vs 36.0%, p=0.558) between the two groups. Kaplan-Meier analysis demonstrated no significant differences in mortality rates between the two groups (53.8% multi-vessel intervention vs 46.8% culprit vessel intervention, P=0.252) during the follow-up period. After multivariate cox analysis (HR: 0.73 95% CI: 0.54-0.98) and the use of propensity matching (HR: 0.85 95% CI: 0.64-0.99) multi-vessel intervention was associated with reduced mortality.
Cardiogenic shock remains a major cause of mortality after AMI. Due to the high mortality rates in this large cohort of patients with AMI complicated by cardiogenic shock, MV intervention appears to be beneficial compared to CV intervention. Hence, a randomised-controlled trial should help to address these issues.
CORONARY: Hemodynamic Support and Cardiogenic Shock