Culprit Vessel–Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment–Elevation Myocardial Infarction: A Collaborative Meta-Analysis
The optimal revascularization strategy in patients with multivessel disease presenting with cardiogenic shock complicating ST-segment–elevation myocardial infarction remains unknown.Methods and Results—
Databases were searched from 1999 to October 2016. Studies comparing immediate/single-stage multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel–only PCI (CO-PCI) in patients with multivessel disease, ST-segment–elevation myocardial infarction, and cardiogenic shock were included. Primary end point was short-term (in-hospital or 30 days) mortality. Secondary end points included long-term mortality, cardiovascular death, reinfarction, and repeat revascularization. Safety end points were in-hospital stroke, renal failure, and major bleeding. The meta-analysis included 11 nonrandomized studies and 5850 patients (1157 MV-PCI and 4693 CO-PCI). There was no significant difference in short-term mortality with MV-PCI versus CO-PCI (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81–1.43; P=0.61). Similarly, there were no significant differences in long-term mortality (OR, 0.84; 95% CI, 0.54–1.30; P=0.43), cardiovascular death (OR, 0.72; 95% CI, 0.42–1.23; P=0.23), reinfarction (OR, 1.65; 95% CI, 0.84–3.26; P=0.15), or repeat revascularization (OR, 1.13; 95% CI, 0.76–1.69; P=0.54) between the 2 groups. There was a nonsignificant trend toward higher in-hospital stroke (OR, 1.64; 95% CI, 0.98–2.72; P=0.06) and renal failure (OR, 1.30; 95% CI, 0.98–1.72; P=0.06), with no difference in major bleeding (OR, 1.47; 95% CI, 0.39–5.63; P=0.57) with MV-PCI when compared with CO-PCI.Conclusions—
This meta-analysis of nonrandomized studies suggests that in patients with cardiogenic shock complicating ST-segment–elevation myocardial infarction, there may be no significant benefit with single-stage MV-PCI compared with CO-PCI. Given the limitations of observational data, randomized trials are needed to determine the role of MV-PCI in this setting.