Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis

Suzanne de Waha; Alexander Jobs; Ingo Eitel; Janine Pöss; Thomas Stiermaier; Roza Meyer-Saraei; Georg Fuernau; Uwe Zeymer; Steffen Desch; Holger Thiele

doi:10.1177/2048872617719640

Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis

Suzanne de Waha, Alexander Jobs, Ingo Eitel, Janine Pöss, Thomas Stiermaier, Roza Meyer-Saraei, Georg Fuernau, Uwe Zeymer, Steffen Desch, Holger Thiele

Klinikum der Stadt Ludwigshafen

30 Citations (Scopus)

Abstract

BACKGROUND: Early revascularisation of the culprit lesion is the therapeutic cornerstone in cardiogenic shock complicating acute myocardial infarction. The optimal management of additional non-culprit lesions is unclear. This systematic review and meta-analysis aims to summarise current evidence on the comparison of immediate multivessel percutaneous coronary intervention (MV-PCI) or culprit lesion only PCI with possible staged revascularisation (C-PCI) in patients with cardiogenic shock complicating acute myocardial infarction.

METHODS: Medical literature databases were screened to identify analyses comparing MV-PCI with C-PCI in patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease. In absence of randomised trials, 10 cohort studies were included in the current meta-analysis. The primary outcome of short-term mortality was assessed at hospital discharge or 30 days after hospital admission. Secondary outcomes were long-term mortality as well as myocardial re-infarction, stroke, acute renal failure, and bleeding at short-term follow-up.

RESULTS: Of 6051 patients, 1194 (19.7%) received MV-PCI and 4857 (80.3%) C-PCI. Short-term mortality was 37.5% in patients undergoing MV-PCI compared with 28.8% in C-PCI patients (risk ratio 1.26, 95% confidence interval 1.12-1.41, p=0.001). Long-term mortality ( p=0.77), myocardial re-infarction ( p=0.77), stroke ( p=0.12), acute renal failure ( p=0.17) and bleeding ( p=0.53) did not differ significantly between the two revascularisation groups.

CONCLUSIONS: Results of this first meta-analysis on the interventional management of patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease do not support MV-PCI over C-PCI. However, possible treatment selection bias in the individual studies must be taken into account.

Original language	English
Journal	European heart journal. Acute cardiovascular care
Volume	7
Issue number	1
Pages (from-to)	28-37
Number of pages	10
DOIs	https://doi.org/10.1177/2048872617719640
Publication status	Published - 01.02.2018

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Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)

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10.1177/2048872617719640

Cite this

de Waha, S., Jobs, A., Eitel, I., Pöss, J., Stiermaier, T., Meyer-Saraei, R., Fuernau, G., Zeymer, U., Desch, S., & Thiele, H. (2018). Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis. European heart journal. Acute cardiovascular care, 7(1), 28-37. https://doi.org/10.1177/2048872617719640

@article{ae907b71cecd4b32a3ce609c517f84fe,

title = "Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis",

abstract = "BACKGROUND: Early revascularisation of the culprit lesion is the therapeutic cornerstone in cardiogenic shock complicating acute myocardial infarction. The optimal management of additional non-culprit lesions is unclear. This systematic review and meta-analysis aims to summarise current evidence on the comparison of immediate multivessel percutaneous coronary intervention (MV-PCI) or culprit lesion only PCI with possible staged revascularisation (C-PCI) in patients with cardiogenic shock complicating acute myocardial infarction.METHODS: Medical literature databases were screened to identify analyses comparing MV-PCI with C-PCI in patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease. In absence of randomised trials, 10 cohort studies were included in the current meta-analysis. The primary outcome of short-term mortality was assessed at hospital discharge or 30 days after hospital admission. Secondary outcomes were long-term mortality as well as myocardial re-infarction, stroke, acute renal failure, and bleeding at short-term follow-up.RESULTS: Of 6051 patients, 1194 (19.7%) received MV-PCI and 4857 (80.3%) C-PCI. Short-term mortality was 37.5% in patients undergoing MV-PCI compared with 28.8% in C-PCI patients (risk ratio 1.26, 95% confidence interval 1.12-1.41, p=0.001). Long-term mortality ( p=0.77), myocardial re-infarction ( p=0.77), stroke ( p=0.12), acute renal failure ( p=0.17) and bleeding ( p=0.53) did not differ significantly between the two revascularisation groups.CONCLUSIONS: Results of this first meta-analysis on the interventional management of patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease do not support MV-PCI over C-PCI. However, possible treatment selection bias in the individual studies must be taken into account.",

author = "{de Waha}, Suzanne and Alexander Jobs and Ingo Eitel and Janine P{\"o}ss and Thomas Stiermaier and Roza Meyer-Saraei and Georg Fuernau and Uwe Zeymer and Steffen Desch and Holger Thiele",

year = "2018",

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doi = "10.1177/2048872617719640",

language = "English",

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de Waha, S, Jobs, A, Eitel, I, Pöss, J, Stiermaier, T , Meyer-Saraei, R , Fuernau, G, Zeymer, U, Desch, S & Thiele, H 2018, 'Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis', European heart journal. Acute cardiovascular care, vol. 7, no. 1, pp. 28-37. https://doi.org/10.1177/2048872617719640

Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis. / de Waha, Suzanne; Jobs, Alexander; Eitel, Ingo et al.
In: European heart journal. Acute cardiovascular care, Vol. 7, No. 1, 01.02.2018, p. 28-37.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis

AU - de Waha, Suzanne

AU - Jobs, Alexander

AU - Eitel, Ingo

AU - Pöss, Janine

AU - Stiermaier, Thomas

AU - Meyer-Saraei, Roza

AU - Fuernau, Georg

AU - Zeymer, Uwe

AU - Desch, Steffen

AU - Thiele, Holger

PY - 2018/2/1

Y1 - 2018/2/1

N2 - BACKGROUND: Early revascularisation of the culprit lesion is the therapeutic cornerstone in cardiogenic shock complicating acute myocardial infarction. The optimal management of additional non-culprit lesions is unclear. This systematic review and meta-analysis aims to summarise current evidence on the comparison of immediate multivessel percutaneous coronary intervention (MV-PCI) or culprit lesion only PCI with possible staged revascularisation (C-PCI) in patients with cardiogenic shock complicating acute myocardial infarction.METHODS: Medical literature databases were screened to identify analyses comparing MV-PCI with C-PCI in patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease. In absence of randomised trials, 10 cohort studies were included in the current meta-analysis. The primary outcome of short-term mortality was assessed at hospital discharge or 30 days after hospital admission. Secondary outcomes were long-term mortality as well as myocardial re-infarction, stroke, acute renal failure, and bleeding at short-term follow-up.RESULTS: Of 6051 patients, 1194 (19.7%) received MV-PCI and 4857 (80.3%) C-PCI. Short-term mortality was 37.5% in patients undergoing MV-PCI compared with 28.8% in C-PCI patients (risk ratio 1.26, 95% confidence interval 1.12-1.41, p=0.001). Long-term mortality ( p=0.77), myocardial re-infarction ( p=0.77), stroke ( p=0.12), acute renal failure ( p=0.17) and bleeding ( p=0.53) did not differ significantly between the two revascularisation groups.CONCLUSIONS: Results of this first meta-analysis on the interventional management of patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease do not support MV-PCI over C-PCI. However, possible treatment selection bias in the individual studies must be taken into account.

AB - BACKGROUND: Early revascularisation of the culprit lesion is the therapeutic cornerstone in cardiogenic shock complicating acute myocardial infarction. The optimal management of additional non-culprit lesions is unclear. This systematic review and meta-analysis aims to summarise current evidence on the comparison of immediate multivessel percutaneous coronary intervention (MV-PCI) or culprit lesion only PCI with possible staged revascularisation (C-PCI) in patients with cardiogenic shock complicating acute myocardial infarction.METHODS: Medical literature databases were screened to identify analyses comparing MV-PCI with C-PCI in patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease. In absence of randomised trials, 10 cohort studies were included in the current meta-analysis. The primary outcome of short-term mortality was assessed at hospital discharge or 30 days after hospital admission. Secondary outcomes were long-term mortality as well as myocardial re-infarction, stroke, acute renal failure, and bleeding at short-term follow-up.RESULTS: Of 6051 patients, 1194 (19.7%) received MV-PCI and 4857 (80.3%) C-PCI. Short-term mortality was 37.5% in patients undergoing MV-PCI compared with 28.8% in C-PCI patients (risk ratio 1.26, 95% confidence interval 1.12-1.41, p=0.001). Long-term mortality ( p=0.77), myocardial re-infarction ( p=0.77), stroke ( p=0.12), acute renal failure ( p=0.17) and bleeding ( p=0.53) did not differ significantly between the two revascularisation groups.CONCLUSIONS: Results of this first meta-analysis on the interventional management of patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease do not support MV-PCI over C-PCI. However, possible treatment selection bias in the individual studies must be taken into account.

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U2 - 10.1177/2048872617719640

DO - 10.1177/2048872617719640

M3 - Journal articles

C2 - 28703046

AN - SCOPUS:85037174537

SN - 2048-8734

VL - 7

SP - 28

EP - 37

JO - European heart journal. Acute cardiovascular care

JF - European heart journal. Acute cardiovascular care

IS - 1

ER -

Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis

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