By Bruce Sylvester
ORLANDO, Fla -- November 18, 2009 -- Multivessel primary percutaneous coronary intervention (PCI) is not associated with a decrease in 1-year mortality in patients with multivessel disease (MVD) and ST-elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS), compared with culprit vessel-only PCI.
"Patients treated with multivessel PCI and patients treated with culprit vessel-only PCI had a comparable 1-year mortality, which was very high in both groups -- above 50%," said lead investigator Bimmer Claessen, MD, Academic Medical Center at the University of Amsterdam, Amsterdam, the Netherlands, at a presentation on November 15 at the American Heart Association (AHA) Scientific Sessions 2009.
Between 1997 and 2005, Dr. Claessen and colleagues enrolled 161 consecutive patients with STEMI complicated with CS who had been admitted to 1 hospital site, and treated with primary PCI. They identified patients with MVD with a coronary angiogram and defined MVD at least 1 stenosis >50% in a non-infarct related coronary artery.
At the discretion of the clinicians, they performed multivessel PCI (23%; n = 37) or culprit vessel-only PCI (77%; n = 124).
Baseline patient characteristics were similar between groups. However, patients treated with multivessel primary PCI significantly more often received glycoprotein IIa/IIIb inhibitors during the procedure, compared with culprit vessel-only PCI (P = .03).
The investigators used standard statistical tools to evaluate and compare the data.
For the primary outcome, the researchers reported that 1-year mortality was comparable between patients in the multivessel and culprit vessel-only PCI groups (60% vs 52%, respectively; P = .45).
"This study is highly suggestive of the need for larger trials to study the relative efficacy of these 2 alternative procedures in this high-mortality patient population," said Dr. Claessen.
[Presentation title: Multivessel Primary Percutaneous Coronary Intervention in Patients With Multivessel Disease and ST-Elevation Myocardial Infarction Complicated With Cardiogenic Shock. Abstract 4191]
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