title: 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.
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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov , NCT00491036.
authors.affiliation: 1 Klinikum Ludwigshafen, Medizinische Klinik B, Germany.|2 Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: 3 Universitätsklinikum Halle, Klinik für Kardiologie, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.affiliation: 4 Universität Leipzig, Herzzentrum, Kardiologie, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: 1 Klinikum Ludwigshafen, Medizinische Klinik B, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.affiliation: 5 Herzzentrum Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: 4 Universität Leipzig, Herzzentrum, Kardiologie, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fürnau
authors.affiliation: 6 Herzzentrum Bad Segeberg, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: 2 Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.affiliation: 4 Universität Leipzig, Herzzentrum, Kardiologie, Germany.|7 Medical Clinic II, Universitäres Herzzentrum Lübeck University Hospital Schleswig-Holstein, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Multivessel percutaneous coronary intervention; cardiogenic shock; culprit artery; mortality; myocardial infarction