title: Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock.
abstract: OBJECTIVE
  The value of multivessel revascularisation in cardiogenic shock and multivessel disease (MVD) is still not clear. We compared outcomes following culprit vessel or multivessel revascularisation in patients with ST-elevation myocardial infarction (STEMI), cardiogenic shock and MVD.
  
  
  METHODS
  From 16 620 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in a nationwide, prospective, multicentre registry between January 2006 and December 2012, 510 eligible patients were selected and divided into culprit vessel revascularisation (n=386, 75.7%) and multivessel revascularisation (n=124, 24.3%) groups. The primary outcomes were inhospital mortality and all-cause death during a median 194-day follow-up. A weighted Cox regression model was constructed to determine the HRs and 95% CIs for outcomes in the two groups.
  
  
  RESULTS
  Compared with culprit vessel revascularisation, multivessel revascularisation had a significantly lower adjusted risk of inhospital mortality (9.3% vs 2.4%, HR 0.263, 95% CI 0.149 to 0.462, p<0.001) and all-cause death (13.1% vs 4.8%, HR 0.400, 95% CI 0.264 to 0.606, p<0.001), mainly because of fewer cardiac deaths (9.7% vs 4.8%, HR 0.510, 95% CI 0.329 to 0.790, p=0.002). In addition, multivessel revascularisation significantly decreased the adjusted risk of the composite endpoint of all-cause death, recurrent myocardial infarction and any revascularisation (20.3% vs 18.1%, HR 0.728, 95% CI 0.55 to 0.965, p=0.026).
  
  
  CONCLUSIONS
  This study showed that, compared with culprit vessel revascularisation, multivessel revascularisation at the time of primary PCI was associated with better outcomes in patients with STEMI with cardiogenic shock. Our results support the current guidelines regarding revascularisation in these patients.
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Jin Sup
authors: JS
authors: Park
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
authors: Kwang Soo
authors: KS
authors: Cha
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Dae Sung
authors: DS
authors: Lee
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Donghun
authors: D
authors: Shin
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Hye Won
authors: HW
authors: Lee
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Jun-Hyok
authors: JH
authors: Oh
authors: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors: Jeong Su
authors: JS
authors: Kim
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Jung Hyun
authors: JH
authors: Choi
authors: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors: Yong Hyun
authors: YH
authors: Park
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Han Cheol
authors: HC
authors: Lee
authors: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors: June Hong
authors: JH
authors: Kim
authors: Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors: Kook-Jin
authors: KJ
authors: Chun
authors: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors: Taek Jong
authors: TJ
authors: Hong
authors: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors: Myung Ho
authors: MH
authors: Jeong
authors: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors: Youngkeun
authors: Y
authors: Ahn
authors: Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea.
authors: Shung Chull
authors: SC
authors: Chae
authors: Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea.
authors: Young Jo
authors: YJ
authors: Kim
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome