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Outcomes of multivessel vs culprit lesion‐only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta‐analysis
Author(s) -
Kundu Amartya,
Sardar Partha,
Kakouros Nikolaos,
Malhotra Rohit,
Kolte Dhaval,
Feldman Dmitriy N.,
Abbott JD,
Fisher Daniel Z.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28062
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , cardiogenic shock , myocardial infarction , cardiology , culprit , stroke (engine) , revascularization , odds ratio , mechanical engineering , engineering
Objectives This updated meta‐analysis evaluated outcomes with multi‐vessel (MV‐PCI) vs culprit lesion‐only percutaneous coronary intervention (CL‐PCI), in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Background There is considerable debate regarding the optimal revascularization strategy in patients with AMI and CS, particularly regarding management of non‐culprit lesions. Methods Databases were searched for studies comparing MV‐PCI and CL‐PCI in patients with AMI and CS. The primary outcome of interest was short‐term all‐cause mortality. Secondary outcomes included long‐term mortality, repeat revascularization and myocardial reinfarction. Safety outcomes were stroke, acute renal failure and major bleeding. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects models. Results Our meta‐analysis consisting of 14 studies (13 observational, 1 RCT) involving 8,552 patients showed that in comparison to CL‐PCI, MV‐PCI was associated with similar short‐term mortality (OR 1.14; 95% CI 0.9–1.43), as well as similar long‐term mortality (OR 0.94; 95% CI 0.68–1.28). There was no significant difference in the risk of myocardial reinfarction (OR 1.19; 95% CI 0.76–1.86), or repeat revascularization (OR 0.79; 95% CI 0.41–1.55) between the two groups. Compared to CL‐PCI, MV‐PCI was associated with a similar risk of bleeding (OR 1.13; 95% CI 0.91–1.40) and stroke (OR 1.28; 95% CI 0.84–1.96), but a higher risk of developing renal failure (OR 1.32; 95% CI 1.05–1.65). Conclusions Our meta‐analysis suggests that there is a higher risk of renal failure with no additional benefit in efficacy outcomes with MV‐PCI, compared to CL‐PCI in patients with AMI and CS.