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Multivessel vs. Culprit Vessel-Only Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients With Cardiogenic Shock: An Updated Systematic Review and Meta-Analysis

BACKGROUND: The optimal revascularization strategy in patients with ST-segment elevation myocardial infarction (STEMI) complicating by cardiogenic shock (CS) remains controversial. This study aims to evaluate the clinical outcomes of multivessel percutaneous coronary intervention (MV-PCI) compared t...

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Detalles Bibliográficos
Autores principales: Xiong, Bingquan, Yang, Huiping, Yu, Wenlong, Zeng, Yunjie, Han, Yue, She, Qiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9051032/
https://www.ncbi.nlm.nih.gov/pubmed/35497976
http://dx.doi.org/10.3389/fcvm.2022.735636
Descripción
Sumario:BACKGROUND: The optimal revascularization strategy in patients with ST-segment elevation myocardial infarction (STEMI) complicating by cardiogenic shock (CS) remains controversial. This study aims to evaluate the clinical outcomes of multivessel percutaneous coronary intervention (MV-PCI) compared to culprit vessel-only PCI (CO-PCI) for the treatment, only in patients with STEMI with CS. METHODS: A comprehensive literature search was conducted. Studies assessed the efficacy outcomes of short (in-hospital or 30 days)/long-term mortality, cardiac death, myocardial reinfarction, repeat revascularization, and safety outcomes of stroke, bleeding, acute renal failure with MV-PCI vs. CO-PCI in patients with STEMI with CS were included. The publication bias and sensitivity analysis were also performed. RESULTS: A total of 15 studies were included in this meta-analysis. There was no significant difference in short- and long-term mortality in patients treated with MV-PCI compared to CO-PCI group [odds ratio (OR) = 1.17; 95% confidence interval (CI), 0.92–1.48; OR = 0.86; 95% CI, 0.58–1.28]. Similarly, there were no significant differences in cardiac death (OR = 0.67; 95% CI, 0.44–1.00), myocardial reinfarction (OR = 1.24; 95% CI, 0.77–2.00), repeat revascularization (OR = 0.75; 95% CI, 0.40–1.42), bleeding (OR = 1.53; 95% CI, 0.53–4.43), or stroke (OR = 1.42; 95% CI, 0.90–2.23) between the two groups. There was a higher risk in acute renal failure (OR = 1.33; 95% CI, 1.04–1.69) in patients treated with MV-PCI when compared with CO-PCI. CONCLUSION: This meta-analysis suggests that there may be no significant benefit for patients with STEMI complicating CS treated with MV-PCI compared with CO-PCI, and patients are at increased risk of developing acute renal failure after MV-PCI intervention.