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

KAMIR Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)e013870
JournalJournal of the American Heart Association
Volume8
Issue number24
DOIs
StatePublished - 17 Dec 2019

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Cardiogenic Shock
Percutaneous Coronary Intervention
Arteries
Cause of Death
Registries
ST Elevation Myocardial Infarction
Propensity Score
National Institutes of Health (U.S.)
Korea
Pathologic Constriction
Hospitalization
Myocardial Infarction

Keywords

  • ST‐segment–elevation myocardial infarction
  • cardiogenic shock
  • complete revascularization
  • multivessel disease
  • outcomes
  • percutaneous coronary intervention

Cite this

@article{11aaf53709cf460f8ba5fcf427832200,
title = "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",
author = "{KAMIR Investigators} and Lee, {Joo Myung} and Rhee, {Tae Min} and Kim, {Hyun Kuk} and Doyeon Hwang and Lee, {Seung Hun} and Choi, {Ki Hong} and Jihoon Kim and Park, {Taek Kyu} and Yang, {Jeong Hoon} and Song, {Young Bin} and Choi, {Jin Ho} and Choi, {Seung Hyuk} and Koo, {Bon Kwon} and Chae, {Shung Chull} and Cho, {Myeong Chan} and Kim, {Chong Jin} and Kim, {Ju Han} and Kim, {Hyo Soo} and Gwon, {Hyeon Cheol} and Jeong, {Myung Ho} and Hahn, {Joo Yong}",
year = "2019",
month = "12",
day = "17",
doi = "10.1161/JAHA.119.013870",
language = "English",
volume = "8",
pages = "e013870",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "24",

}

TY - JOUR

T1 - 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

AU - KAMIR Investigators

AU - Lee, Joo Myung

AU - Rhee, Tae Min

AU - Kim, Hyun Kuk

AU - Hwang, Doyeon

AU - Lee, Seung Hun

AU - Choi, Ki Hong

AU - Kim, Jihoon

AU - Park, Taek Kyu

AU - Yang, Jeong Hoon

AU - Song, Young Bin

AU - Choi, Jin Ho

AU - Choi, Seung Hyuk

AU - Koo, Bon Kwon

AU - Chae, Shung Chull

AU - Cho, Myeong Chan

AU - Kim, Chong Jin

AU - Kim, Ju Han

AU - Kim, Hyo Soo

AU - Gwon, Hyeon Cheol

AU - Jeong, Myung Ho

AU - Hahn, Joo Yong

PY - 2019/12/17

Y1 - 2019/12/17

N2 - 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.

AB - 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.

KW - ST‐segment–elevation myocardial infarction

KW - cardiogenic shock

KW - complete revascularization

KW - multivessel disease

KW - outcomes

KW - percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85076275754&partnerID=8YFLogxK

U2 - 10.1161/JAHA.119.013870

DO - 10.1161/JAHA.119.013870

M3 - Article

C2 - 31818215

AN - SCOPUS:85076275754

VL - 8

SP - e013870

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 24

ER -