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In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multi-vessel disease, and whether PCI should be performed immediately for stenosis in non-culprit arteries is controversial. The optimal revascularization strategy in patients with multi-vessel disease presenting with cardiogenic shock complicating ST-segment-elevation myocardial infarction remains unknown.
Methods and Results
Databases were searched from 1999 to November 2017. Studies comparing immediate/single-stage multi-vessel percutaneous coronary intervention (MV-PCI) versus culprit vessel-only PCI (CO-PCI) in patients with multi-vessel disease, ST-segment-elevation myocardial infarction, and cardiogenic shock were included. Primary end point was short-term (in-hospital or 30-day) mortality. The meta-analysis included 8 studies and 6341 patients (1423 MV-PCI and 4918 CO-PCI). There was a significant difference in short-term mortality with MV-PCI versus CO-PCI (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.20-1.65; P<0.05).
This updated meta-analysis, which includes the multicenter randomized control trial CULPRIT SHOCK, suggests that in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction, there is a significant benefit in short-term mortality with CO-PCI compared with MV-PCI. Given the limitations of observational data, more randomized trials are needed to validate these findings.