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Culprit-Only Versus Immediate Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicating Advanced Cardiogenic Shock Requiring Venoarterial-Extracorporeal Membrane Oxygenation
- Title
- Culprit-Only Versus Immediate Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicating Advanced Cardiogenic Shock Requiring Venoarterial-Extracorporeal Membrane Oxygenation
- Authors
- Choi K.H.; Yang J.H.; Park T.K.; Lee J.M.; Song Y.B.; Hahn J.-Y.; Choi S.-H.; Ahn C.-M.; Yu C.W.; Park I.H.; Jang W.J.; Kim H.-J.; Bae J.-W.; Kwon S.U.; Lee H.-J.; Lee W.S.; Jeong J.-O.; Park S.-D.; Kang T.-S.; Gwon H.-C.
- Ewha Authors
- 장우진
- SCOPUS Author ID
- 장우진
- Issue Date
- 2023
- Journal Title
- Journal of the American Heart Association
- ISSN
- 2047-9980
- Citation
- Journal of the American Heart Association vol. 12, no. 10
- Keywords
- acute myocardial infarction; cardiogenic shock; culprit; multivessel disease; percutaneous coronary intervention
- Publisher
- American Heart Association Inc.
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- BACKGROUND: Despite the benefit of culprit-only percutaneous coronary intervention (PCI) in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multi-vessel PCI in Cardiogenic Shock) trial, the optimal revascularization strategy for refractory car-diogenic shock (CS) requiring mechanical circulatory support devices remains controversial. This study aimed to compare clinical outcomes between the culprit-only and immediate multivessel PCI strategies in patients with acute myocardial infarction complicated by CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. METHODS AND RESULTS: This study included patient-pooled data from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Devices for Korean Patients With Cardiogenic Shock) and SMC-ECMO (Samsung Medical Center– Extracorporeal Membrane Oxygenation) registries. A total of 315 patients with acute myocardial infarction with multivessel disease who underwent venoarterial-extracorporeal membrane oxygenation before revascularization attributable to refractory CS were included in this analysis. The study population was classified into culprit-only versus immediate multivessel PCI according to nonculprit lesion treatment strategies. The primary end point was 30-day mortality or renal-replacement therapy, and the key secondary end point was 12-month follow-up mortality. Among the study population, 175 (55.6%) underwent culprit-only PCI and 140 (44.4%) underwent immediate multivessel PCI. Compared with culprit-only PCI, immediate multivessel PCI was associated with significantly lower risks of 30-day mortality or renal-replacement therapy (68.0% versus 54.3%; P=0.018) and all-cause mortality during 12 months of follow-up (59.5% versus 47.5%; hazard ratio [HR], 0.689 [95% CI, 0.506– 0.939]; P=0.018) in patients with acute myocardial infarction and CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. These results were also consistent in the 99 pairs of propensity score– matched population (60.6% versus 43.6%; HR, 0.622 [95% CI, 0.420– 0.922]; P=0.018). CONCLUSIONS: Among patients with acute myocardial infarction with multivessel disease complicated by advanced CS requiring venoarterial-extracorporeal membrane oxygenation before revascularization, immediate multivessel PCI was associated with lower incidences of 30-day mortality or renal replacement therapy and 12-month follow-up mortality, compared with culprit-only PCI. REGISTRATION INFORMATION: clinicaltrials.gov. Identifier: NCT02985008. © 2023 The Authors.
- DOI
- 10.1161/JAHA.123.029792
- Appears in Collections:
- 의료원 > 의료원 > Journal papers
- Files in This Item:
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