Comparison of Long-Term Clinical Outcome Between Multivessel Percutaneous Coronary Intervention Versus Infarct-Related Artery-Only Revascularization for Patients With ST-Segment-Elevation Myocardial Infarction With Cardiogenic Shock

Abstract

Background Data are limited regarding long-term outcomes in patients with ST-segment-elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3-year clinical outcomes of patients with ST-segment-elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct-related artery (IRA)-only PCI. Methods and Results Of 13 104 patients from the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction Registry--National Institutes of Health) registry, we selected 659 patients with ST-segment-elevation myocardial infarction who had concomitant non-IRA stenosis and presented with cardiogenic shock. The primary outcome was all-cause death. Multivessel PCI was performed in 260 patients and IRA-only PCI in 399 patients. At 3 years, patients in the multivessel PCI group had a lower risk of all-cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45-0.94 [P=0.024]), all-cause death or MI (adjusted hazard ratio, 0.59; 95% CI, 0.41-0.84 [P=0.004]), and non-IRA repeat revascularization (adjusted hazard ratio, 0.23; 95% CI, 0.10-0.50 [P<0.001]) than those in the IRA-only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non-IRA repeat revascularization beyond 1 year (log-rank P=0.030 and P=0.017, respectively) than the IRA-only PCI group. Conclusions In patients with ST-segment-elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all-cause death than IRA-only PCI at 3 years, suggesting potential benefit of non-IRA revascularization during the index hospitalization to improve long-term clinical outcomes.

Keywords: ST‐segment–elevation myocardial infarction; cardiogenic shock; complete revascularization; multivessel disease; outcomes; percutaneous coronary intervention.

Figure 1

Study Flow. Study flow of patient selection and follow‐up are presented. IRA indicates infarct‐related artery; KAMIR‐NIH, Korea Acute Myocardial Infarction Registry––National Institutes of Health; NSTEMI, non–ST‐segment–elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST‐segment–elevation myocardial infarction.

Figure 2

Cumulative incidence of clinical outcomes at 3 years. Kaplan‐Meier curves with cumulative hazards of (A) all‐cause death, (B) all‐cause death or recurrent myocardial infarction (MI), (C) recurrent MI, (D) non–infarct‐related artery (IRA) repeat revascularization, (E) any repeat revascularization, and (F) patient‐oriented composite outcome (POCO), compared according to the percutaneous coronary intervention (PCI) strategy.

Figure 3

Landmark analysis of clinical outcomes from 1 year. Landmark analysis from 1 year of composite end points and individual outcomes, (A) all‐cause death, (B) all‐cause death or recurrent myocardial infarction (MI), (C) recurrent MI, (D) non–infarct‐related artery (IRA) repeat revascularization, (E) any repeat revascularization, and (F) patient‐oriented composite outcome (POCO). PCI indicates percutaneous coronary intervention.