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. 2023 Nov;39(6):817-830.
doi: 10.6515/ACS.202311_39(6).20230307A.

Renal Impact of Culprit-Only versus Multi-Vessel Revascularization for Cardiogenic Shock Complicating Acute Myocardial Infarction: Systematic Review and Meta-Analysis

Ting-Wei Kao  1 , Ching-Chang Huang  2 , Cheng-Hsuan Tsai  3 , Jui-Yi Chen  4   5 , Tao-Min Huang  6   7 , Ting-Tse Lin  2 , Chi-Sheng Hung  2 , Vin-Cent Wu  6   7 , Hsien-Li Kao  2 , Wen-Jone Chen  2 , Yen-Hung Lin  2
Affiliations

Renal Impact of Culprit-Only versus Multi-Vessel Revascularization for Cardiogenic Shock Complicating Acute Myocardial Infarction: Systematic Review and Meta-Analysis

Ting-Wei Kao et al. Acta Cardiol Sin. 2023 Nov.

Abstract

Background: The optimal strategy of percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated with cardiogenic shock (CS) remains controversial. We aimed to elucidate the renal and cardiovascular impact of culprit-only (C) revascularization versus additional interventions on non-infarct-related arteries.

Methods: PubMed, Embase, MEDLINE, and Cochrane Library were searched for relevant literature. A total of 96,812 subjects [C-PCI: 69,986; multi-vessel (MV)-PCI: 26,826] in nine studies (one randomized control trial; eight observational cohort studies) were enrolled.

Results: MV-PCI was associated with a higher kidney event rate [relative risk (RR): 1.29, 95% confidence interval (CI): 1.12-1.49; p < 0.001]. However, the all-cause mortality rate was comparable both during admission (RR: 1.07, 95% CI: 0.94-1.22; p = 0.30) and at one year (RR: 0.96, 95% CI: 0.79-1.16; p = 0.65). MV-PCI was associated with a greater risk of stroke (RR: 1.19, 95% CI: 1.08-1.32; p < 0.001) and bleeding events (RR: 1.27, 95% CI: 1.07-1.51; p = 0.006), but reduced risk of recurrent MI (RR: 0.89, 95% CI: 0.82-0.97; p = 0.009) and repeat revascularization (RR: 0.34, 95% CI: 0.16-0.71; p = 0.004). No increased risk of coronary artery bypass grafting was present (RR: 1.09, 95% CI: 0.38-3.17; p = 0.87).

Conclusions: C-PCI was associated with a lower rate of renal dysfunction but not all-cause mortality in patients with CS complicating acute MI.

Keywords: Angiography; Cardiogenic shock; Meta-analysis; Myocardial infarction; Percutaneous coronary revascularization.

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Conflict of interest statement

All the authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study inclusion. CS, cardiogenic shock; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Forest plot comparing kidney events after either multi-vessel (MV) or culprit-only (C) revascularization. CI, confidence interval; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Trial sequential analysis of the low risk of bias in studies comparing the impact on renal events between multi-vessel (MV) and culprit-only (C) revascularization. PCI, percutaneous coronary intervention.
Figure 4
Figure 4
Forest plots comparing all-cause mortality after either multi-vessel (MV) or culprit-only (C) revascularization (A) during admission; (B) at one-year. CI, confidence interval; PCI, percutaneous coronary intervention.
Figure 5
Figure 5
Forest plots comparing the relative risk of secondary outcomes (A) reinfarction; (B) repeat revascularization; (C) coronary artery bypass grafting; (D) bleeding; (E) stroke. C, culprit-only; CI, confidence interval; MV, multi-vessel; PCI, percutaneous coronary intervention.
Central Illustration
Central Illustration
Revascularization strategy for acute MI complicated with cardiogenic shock. C, culprit-only; CABG, coronary artery bypass grafting; MI, myocardial infarction; MV, multi-vessel; PCI, percutaneous coronary intervention; RCT, randomized control trial; Revasc, revascularization.
Supplementary Figure 1
Supplementary Figure 1
Assessing the risk of bias of the included observational cohort studies.
Supplementary Figure 2
Supplementary Figure 2
Funnel plots for (A) kidney events; (B) all-cause mortality during admission; (C) all-cause mortality at one-year; (D) reinfarction; (E) repeat revascularization; (F) coronary artery bypass grafting; (G) bleeding; (H) stroke.
See this image and copyright information in PMC

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