CBS 2019
CBSMD教育中心
中 文

Acute Coronary Syndrom

Abstract

Recommended Article

Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction Comparison of Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention Analyzed by Age Groups (<75, 75 to 85, and >85 Years); (Results from the Bremen STEMI Registry) Optimal Timing of Intervention in NSTE-ACS Without Pre-Treatment The EARLY Randomized Trial Early Diagnosis of Myocardial Infarction With Point-of-Care High-Sensitivity Cardiac Troponin I Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non-ST-Segment Elevation Acute Myocardial Infarction Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis Cardiac monocytes and macrophages after myocardial infarction Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study

Original Research2017 Oct;6(7):601-609.

JOURNAL:Eur Heart J Acute Cardiovasc Care. Article Link

Editor's Choice- Impact of immediate multivessel percutaneous coronary intervention versus culprit lesion intervention on 1-year outcome in patients with acute myocardial infarction complicated by cardiogenic shock: Results of the randomised IABP-SHOCK II trial

Zeymer U, Werdan K, Thiele H et al. Keywords: multivessel percutaneous coronary intervention; cardiogenic shock; culprit artery; mortality; myocardial infarction; IABP-SHOCK II trial

ABSTRACT


BACKGROUND - Current guidelines recommend immediate multivessel percutaneous coronary intervention (PCI) in patients with cardiogenic shock, despite the lack of randomised trials. We sought to investigate the use and impact on outcome of multivessel PCI in comparison to culprit lesion only PCI in a retrospective analysis in patients with cardiogenic shock complicating acute myocardial infarction.

 

METHODS AND RESULTS - In the randomised IABP-SHOCK II trial, investigating the effect of intra-aortic balloon pump on outcome, 451 (75%) of the total of 600 patients had multivessel coronary artery disease and underwent PCI. Immediate multivessel PCI was performed in 167 (37%) patients. TIMI 3 patency after PCI in all treated vessels was observed in 83.2% versus 79.0% of patients after multivessel versus culprit lesion PCI, respectively. The 30-day (44.9% vs. 42.3%) and 12-month (54.8% vs. 52.7%) mortality rates did not significantly differ between the two groups. In the multivariate analysis multivessel PCI was not associated with an improved mortality after 12 months (odds ratio 0.92, 95% confidence intervals 0.69-1.21).

 

CONCLUSION - In this retrospective analysis of the largest randomised study in cardiogenic shock immediate multivessel PCI was used in approximately one third of patients with cardiogenic shock. There was no benefit with immediate multivessel PCI in comparison to culprit lesion only PCI. Therefore a randomised trial is needed to determine the definitive role of multivessel PCI in cardiogenic shock.

 

CLINICAL TRIAL REGISTRATION - ClinicalTrials.gov , NCT00491036.