Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Acute Myocardial Infarction with Cardiogenic Shock: A Systematic Review and Meta-Analysis |
| |
| Affiliation: | 1. Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;2. Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA;3. Department of Internal Medicine, John H. Stroger Cook County Hospital, Chicago, IL, USA;4. Vanderbilt University Medical Center, Nashville, TN, USA;5. Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA;6. Division of Cardiovascular Medicine, Veterans Affairs Mountain Home, Johnson City, TN, USA;7. Cardiovascular Division, University of Miami Miller School of Medicine, Miami, USA;8. VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA;1. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK;2. Brighton and Sussex Medical School, BN1 9PX, UK;1. New York University School of Medicine, New York, NY, USA;2. Department of Cardiology, L.R.G. Naidu Cardiology Research Institute and Clinic, Kuppuswamy Naidu Memorial Hospital, Coimbatore, India;3. Department of Cardiology, The Madras Medical Mission, Chennai, India;4. Department of Cardiology, Sir Ganga Ram Hospitals, New Delhi, India;5. Department of Cardiology, Krishna Institute of Medical Sciences, Secunderabad, India;6. Batra Hospital and Medical Research Center, New Delhi, India;1. Department of Cardiology, Radboudumc, Nijmegen, The Netherlands;2. Department of Cardiology, ErasmusMC, Rotterdam, The Netherlands;1. Dept. of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;2. Dept. of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland |
| |
| Abstract: | BackgroundPrevious studies comparing outcomes between culprit vessel only percutaneous coronary intervention (CV-PCI) versus multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock in the setting of acute myocardial infarction have shown conflicting results. This meta-analysis investigates the optimal approach for management of these patients considering recently published data.MethodsElectronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all clinical studies published until May 1, 2018, which compared outcomes in patients presenting with acute myocardial infarction and cardiogenic shock. Studies comparing CV-PCI versus MV-PCI in patients with multivessel coronary artery disease were screened for inclusion in final analysis. The primary end point was in-hospital/30 day mortality. Secondary endpoints included long term (>6 months) mortality, renal failure requiring renal replacement therapy, stroke, bleeding, and recurrent myocardial infarction. Odds ratio (OR) with 95% of confidence interval (CI) were computed and p values <0.05 were considered significant.ResultsPatient who underwent CV-PCI had significantly lower short-term mortality (in-hospital or 30-day mortality) (OR: 0.73, CI: 0.61–0.87, p = 0.0005), and lower odds of severe renal failure requiring renal replacement therapy (OR: 0.76, CI: 0.59‐0.98, p = 0.03). There was no statistically significant difference in long-term mortality, stroke, bleeding, and recurrent myocardial infarction between two groups.ConclusionThis meta-analysis showed lower short-term mortality and decreased odds of renal failure requiring renal replacement therapy with CV-PCI compared to MV-PCI. However, subgroup analysis including studies exclusively assessing STEMI patients revealed no statistically significant difference in outcomes. Further randomized trials are needed to confirm these findings and evaluate long term results. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
