Abstract 4696: Different Outcome in Shock Patients Treated by Multivessel Versus Target-Vessel Only PCI for STEMI and Resuscitated Cardiac Arrest
Background: Whether target-vessel only or full coronary percutaneous coronary angioplasty (PCI) is associated with different outcomes in shock-patients with ST elevation MI (STEMI) is still debated.
Methods: Between 1998 and 2008, a total of 256 patients (Pts) were transported to the cath-lab after successful resuscitation for cardiac arrest complicating STEMI. Among them, 135 had cardiogenic shock on hospital admission. A total of 69/135 Pts had multi-vessel coronary disease. Emergency PCI was attempted in all Pts, including target-vessel only PCI in 42 and full coronary PCI in 27of them. Multi-vessel or target vessel PCI was left to the operator’s choice. We sought to compare the outcome of patients treated with target-vessel only vs. full coronary PCI.
Results: The mean age of the study population was 68 years-old and 80% were males. There was no difference in baseline and pre-hospital characteristics between the two groups. Compared to those treated with multi-vessel coronary intervention, Pts treated with target-vessel-only PCI developed a slightly higher rate of fatal cardiac failure (21/42, 50% vs. 9/27, 33%, p=0.17) and fatal recurrent malign arrhythmia (3/42, 7%, vs. 0/27, p=0.08) during the in-hospital course. Finally, multi-vessel PCI during the initial procedure was associated with an improved 6-months survival rate (41% vs. 17% for patients treated with target-vessel-only PCI, p=0.04).
Conclusion: In shock-Pts treated by emergency PCI for STEMI and resuscitated cardiac arrest, full coronary PCI resulted, when compared to target-vessel only PCI, in better outcome and higher 6-month survival. This strategy should be further investigated in a large multicenter randomized trial. KEY-WORDS Myocardial infarction, Cardiac arrest, Shock, Angioplasty, Percutaneous coronary intervention, revascularization, Outcome.