Author + information
- Received July 5, 2012
- Revision received October 12, 2012
- Accepted October 26, 2012
- Published online February 1, 2013.
- Darren Mylotte, MD⁎,⁎ (, )
- Marie-Claude Morice, MD⁎,
- Hélène Eltchaninoff, MD, PhD†,
- Jérôme Garot, MD, PhD⁎,
- Yves Louvard, MD⁎,
- Thierry Lefèvre, MD⁎ and
- Philippe Garot, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Darren Mylotte, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, 6 Avenue du Noyer Lamber, 91300, Massy, France
Objectives This study sought to assess the impact of multivessel (MV) primary percutaneous coronary intervention (PCI) on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) and resuscitated cardiac arrest (CA).
Background The safety and efficacy of MV primary PCI in patients with STEMI and refractory CS is unknown.
Methods We conducted a multicenter prospective observational study of consecutive STEMI patients presenting to 5 French centers. Patients were classified as having single-vessel (SVD) or multivessel (MVD) coronary disease, and underwent culprit-only or MV primary PCI. Baseline characteristics and 6-month survival were compared.
Results Among 11,530 STEMI patients, 266 had resuscitated CA and CS. Patients with SVD (36.5%) had increased 6-month survival compared to those with MVD (29.6% vs. 42.3%, p = 0.032). Baseline characteristics were similar in those with MVD undergoing culprit-only (60.9%) or MV (39.1%) primary PCI. However, 6-month survival was significantly greater in patients who underwent MV PCI (43.9% vs. 20.4%, p = 0.0017). This survival advantage was mediated by a reduction in the composite of recurrent CA and death due to shock (p = 0.024) in MV PCI patients. In those with MVD, culprit artery PCI success (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.41 to 0.96, p = 0.030) and MV primary PCI (HR: 0.57; 95% CI: 0.38 to 0.84, p = 0.005) were associated with increased 6-month survival.
Conclusions The results of this study suggest that in STEMI patients with MVD presenting with CS and CA, MV primary PCI may improve clinical outcome. Randomized trials are required to verify these results.
- cardiac arrest
- cardiogenic shock
- primary percutaneous coronary intervention
- ST-segment elevation myocardial infarction
Dr. Mylotte is a recipient of a travel bursary from Merck Sharp & Dohme. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 5, 2012.
- Revision received October 12, 2012.
- Accepted October 26, 2012.
- American College of Cardiology Foundation