Revascularization Strategies for Patients with Multivessel CAD and STEMI Complicated by Cardiogenic Shock

By Matt Cavender

Multivessel coronary artery disease is common in patients with ST Elevation Myocardial Infarction complicated by cardiogenic shock. Prior data has suggested that, in this population, undergoing multivessel PCI is associated with worse in-hospital when compared to patients treated with PCI of the culprit artery only. To date, there have been no studies evaluating the long-term outcomes associated with different revascularization strategies.

We studied the outcomes of 199 patients with multivessel coronary artery disease and STEMI complicated by shock who underwent PCI at the Cleveland Clinic between 01/01/2002-6/30/2010. We found that approximately 1 out of 4 of these patients were treated with multivessel PCI. Patients treated with multivessel PCI had higher rates of death at 1 month (27% vs. 46%) and 8 years (65% vs. 75%; p=0.04); however, after adjusting for differences in the patient populations, there were no differences in the risk of death in either the early or late period following the index event.

Our study is the first to compare long term outcomes of different revascularization strategies in patients with MVCAD who present with STEMI complicated by cardiogenic shock. We found that multivessel revascularization is common in patients with multivessel coronary artery disease who present with STEMI complicated by cardiogenic shock. Patients undergoing multivessel revascularization have long-term outcomes comparable to those of patients treated with PCI of the infarct related artery alone. These data provide support for the ACC/AHA guidelines and show that multivessel interventions can be considered in select patient populations.

Matthew A. Cavender, MD is a Research Fellow, TIMI Study Group, Brigham and Women’s Hospital, Harvard Medical School, 350 Longwood Avenue, First Floor Office, Boston, Massachusetts 02115. (617) 278-0140 Email: mcavender@partners.org

Full reference: Cavender MA, Rajeswaran J, DiPaola L, Houghtaling P, Kiernan MS, MD2, Rassi AN, Menon V, Whitlow PW, Ellis SG, Shishehbor MH. Outcomes of Culprit Versus Multivessel PCI in Patients With Multivessel Coronary Artery Disease Presenting With ST-Elevation Myocardial Infarction Complicated by Shock. J INVASIVE CARDIOL 2013;25(5):218-224

 

 

 

 

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