title: Immediate multivessel percutaneous coronary intervention versus culprit lesion intervention in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry.
abstract: OBJECTIVE
  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 current practice in cardiogenic shock in Germany.
  
  
  RESULTS
  Between January 2008 and December 2011 a total of 735 consecutive patients with acute myocardial infarction, cardiogenic shock and multivessel coronary artery disease underwent immediate PCI in 41 hospitals in Germany. Of these, 173 (23.5%) patients were treated with immediate multivessel PCI. The acute success of PCI with respect to TIMI 3 flow did not differ between the groups (82.5% versus 79.6%). In-hospital mortality with multivessel PCI and culprit lesion PCI was 46.8% and 35.8%, respectively. In multivariate analysis multivessel PCI was associated with an increased mortality (odds ratio 1.5; 95% confidence interval 1.15-1.84).
  
  
  CONCLUSIONS
  In current clinical practice in Germany multivessel PCI is used only in one quarter of patients with cardiogenic shock treated with primary PCI. We observed an adverse effect of immediate multivessel PCI. Therefore, a randomised trial is needed to determine the definitive role of multivessel PCI in cardiogenic shock.
authors.affiliation: Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Mathias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.forename: Helmut
authors.initials: H
authors.lastname: Schühlen
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Albrecht
authors.initials: A
authors.lastname: Elsässer
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome