OUTCOMES OF PATIENTS WITH MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK TREATED WITH CULPRIT VESSEL-ONLY VERSUS MULTIVESSEL PRIMARY PCI.

Introduction and objectives. Multivessel primary percutaneous coronary intervention (pPCI) is still often used in patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The study aimed to compare the characteristics and prognosis of patients with CS-STEMI and multivessel coronary disease (MVD) treated with culprit vessel-only pPCI or multivessel pPCI during the initial procedure.
Material and Methods. From 2016 to 2020, 23,703 primary PCI patients with STEMI were included in a national all-comers registry of cardiovascular interventions. From them, a total of 1,213 (5.1%) patients had cardiogenic shock and MVD at admission to the hospital. Initially, 921 (75.9%) patients were treated with CV-pPCI and 292 (24.1%) with MV-pPCI.
Results. Patients with 3-vessel disease and left main disease had a higher probability of being treated with MV-pPCI than patients with 2-vessel disease and patients without left main disease (28.5% vs. 18.6%; p < 0.001 and 37.7% vs. 20.6%; p < 0.001). Mechanical circulatory support systems were more often used in patients with MV-pPCI. 30-day and 1-year all-cause mortality rates were similar in the CV-pPCI and MV-pPCI groups (Odds ratio, 1.01; 95% CI 0.77 to 1.32; p = 0.937 and 1.1; 95% CI 0.84 to 1.44; p = 0.477). The presence of 3-vessel disease and use of ECMO were the strongest adjusted predictors of 30-day and 1-year mortality.
Conclusions. Our data from a large all-comers registry suggest that selective use of MV-pPCI does not increase the all-cause mortality rate in patients with CS-STEMI and MVD in comparison with CV-pPCI.