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There is still uncertainty about the optimal strategy in patients with multivessel disease undergoing primary PCI for cardiogenic shock. Therefore we compared outcome of patients with culprit lesion only PCI and immediate multivessel PCI for cardiogenic shock in a prospective study.
We used the data of the prospective IABP-Shock II trial and included patients with primary PCI for cardiogenic shock with 2–3 vessel disease. We excluded patients with left main PCI and patients with prior coronary artery bypass surgery. Treatment with multivessel PCI or culprit lesion only PCI was left on the discretion of the operator.
Between 2009 and 2011 a total of 450 patients 2–3 vessel disease were treated with primary PCI for cardiogenic shock. Of these 167 (37 %) received immediate multivessel PCI while in the remaining only the culprit vessel was treated.
Baseline characteristics, procedural features and outcomes are given in the table.
|Culprit lesion PCI (n=283||Multivessel PCI (n=167)||p-value|
|Diabetes||32 %||40 %||0.1|
|Renal insuffiency||24 %||20 %||0.2|
|STEMI||77 %||70 %||0.5|
|3-vessel disease||62 %||72 %||0.04|
|TIMI 3 after PCI||80 %||83 %||0.3|
|IABP||51 %||52 %||0,3|
|30-d reinfarction||2.3 %||1.0 %||0.5|
|30-d mortality||43.8 %||47.3 %||0.5|
Immediate multivessel PCI for cardiogenic shock used in about 40 % of patients is associated with similar success rates as culprit lesion PCI, but with a slightly higher mortality. Therefore a randomized trial seems warranted to evaluate the optimal interventional strategy in these patients.
Oral Contributions West, Room 3001
Sunday, March 10, 2013, 8:00 a.m.-8:15 a.m.
Session Title: ACS: Therapies on the Horizon
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 912-3
- 2013 American College of Cardiology Foundation