Abstract 15350: Multivessel Versus Target Lesion Percutaneous Coronary Intervention in Resuscitated Cardiac Arrest Patients with STEMI
Objective. The role of multivessel (MV) PCI in patients with STEMI and cardiogenic shock after resuscitated cardiac arrest is unclear. We sought to compare outcomes following emergent PCI (<12 h after STEMI onset) of the target lesion (TL) with MV PCI in a high-risk STEMI population.
Methods. We performed a prospective multicenter study of consecutive patients presenting with resuscitated cardiac arrest and shock in the setting of STEMI at 5 French tertiary referral centers. The study population was derived from 1,300 resuscitated cardiac arrests referred for coronary angiography. MV disease was defined as TL+≥1 additional significant stenosis. The primary end-point was in-hospital mortality.
Results. Of a total of 86 patients with MV disease, 53 underwent TL PCI and 33 underwent MV PCI. Patients undergoing TL PCI were significantly older (67.0±11.3vs60.3±12.7 yrs,p=0.013), however baseline risk factors, time to CPR (7.6±7.5vs6.7±6.6,p=0.53), and time to defibrillation (14.2±11.3vs12.0±10.3,p=0.36) were similar in each group. The underlying cardiac rhythm was VF in 66.0% and 75.7% of the TV and MV patients respectively (p=0.47). Shock was treated with inotropic drugs in all cases and IABP in 62.3% of TV, and 78.8% of MV cases (p=0.15). The proportion of ventilated patients (88.7%vs78.8%,p=0.23) and the mean EF (29.3±9.0vs28.3±9.1,p=0.62) was also similar between the groups. In both groups, the infarct lesion was most commonly the left anterior descending coronary, and the mean number of diseased vessels was similar (2.4±0.5vs2.5±0.5,p=0.37). On average, 2.2±0.3 vessels were treated in the MVD group, thus the number of implanted stents and total stent length were increased in this group. The peak creatinine kinase (2581±2613vs2293±2577,p=0.62) and serum lactate (9.7±6.5vs8.2±5.1,p=0.26) was also similar in both groups. The primary endpoint was increased in patients with TL PCI compared to those with MV PCI (81.1%vs57.6%,p=0.025).
Conclusion. This study suggests that in critically ill patients presenting with resuscitated cardiac arrest, shock, and STEMI, that MV PCI may reduce mortality compared to TV PCI.
- © 2011 by American Heart Association, Inc.