Abstract 4194: Multivessel Primary Percutaneous Coronary Intervention in Patients With Multivessel Disease and ST-Elevation Myocardial Infarction Complicated With Cardiogenic Shock
Background: Despite early revascularization, mortality remains high in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS). Multivessel disease (MVD) is present in the majority of STEMI patients with CS. We investigated the effect of multivessel primary percutaneous coronary intervention (PCI) as compared to culpritvessel-only PCI on one year mortality in patients with MVD and STEMI complicated with CS.
Methods: Between 1997 and 2005, 292 consecutive patients with STEMI complicated with CS were admitted and treated with primary PCI In our institution. Patients with MVD were identified based on the coronary angiogram. MVD was defined as the presence of at least one stenosis >50% in a non-infarct related coronary artery. A survival plot was calculated using the Kaplan-Meier method, differences between the curves were tested for significance by the log-rank statistic.
Results: MVD was present in 161 patients (55%). Multivessel PCI was performed in 23% (n=37) of patients with MVD and STEMI with CS. Baseline demographic, clinical and treatment variables were comparable between patients treated with multivessel primary PCI and culpritvessel-only PCI, with one exception; patients treated with multivessel primary PCI significantly more often received glycoprotein IIa/IIIb inhibitors during the procedure. One-year mortality was comparable between patients in the multivessel PCI group and patients in the culpritvessel-only PCI group (60% vs 52%, respectively, p=0.45).
Conclusion: In patients with MVD and STEMI complicated with CS, multivessel primary PCI was not associated with a reduction in one-year mortality.