Multivessel vs. culprit vessel-only percutaneous coronary intervention in ST-segment elevation myocardial infarction with and without cardiogenic shock

Jing Wu; Yonggang Wang; Chenguang Li; Honglei Ji; Wenyi Zhao; Qian Tong; Mingyou Zhang

doi:10.3389/fcvm.2022.992456

Multivessel vs. culprit vessel-only percutaneous coronary intervention in ST-segment elevation myocardial infarction with and without cardiogenic shock

Front Cardiovasc Med. 2022 Nov 24:9:992456. doi: 10.3389/fcvm.2022.992456. eCollection 2022.

Authors

Jing Wu¹, Yonggang Wang², Chenguang Li³, Honglei Ji², Wenyi Zhao⁴, Qian Tong², Mingyou Zhang²

Affiliations

¹ Department of Translational Medicine, The First Hospital of Jilin University, Changchun, China.
² Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, China.
³ Department of Cardiology, Zhongshan Hospital, Shanghai, China.
⁴ Department of Nephrology, Linyi Traditional Chinese Medicine Hospital, Linyi, China.

Abstract

Background: Early revascularization of the culprit vessel is the most effective treatment for reducing the risk of mortality from acute STEMI with and without cardiogenic shock. However, the most recent trends and impact of multivessel percutaneous coronary intervention (PCI) during the index hospitalization on in-hospital outcomes are unknown.

Methods: The National Inpatient Sample was queried from October 2015 to 2019 for hospitalizations with STEMI. The impact of multivessel PCI on in-hospital outcomes of patients with and without cardiogenic shock was evaluated.

Results: Of 624,605 STEMI hospitalizations treated with PCI, 12.5% were complicated by cardiogenic shock. Among hospitalizations without cardiogenic shock, 15.7% were treated by multivessel PCI, which declined from 20.8% in 2015 to 13.9% in 2019 (P _trend < 0.001). Multivessel and culprit-only PCI had similar rates of In-hospital mortality (2.4 vs. 2.3%, p = 0.027) and major adverse cardiac and cerebrovascular events (MACCE; 7.4 vs. 7.2%, p = 0.072). Among hospitalizations with cardiogenic shock, 22.1% were treated by multivessel PCI, which declined from 29.2% in 2015 to 19.4% in 2019 (P _trend < 0.001). Multivessel PCI was associated with higher rates of in-hospital mortality (30.9 vs. 28.4%, p < 0.001) and MACCE (39.9 vs. 36.5%, p < 0.001) than culprit-only PCI.

Conclusion: The frequency of multivessel PCI for STEMI with and without cardiogenic shock is declining. Multivessel PCI is associated with worse in-hospital outcomes for STEMI with cardiogenic shock but not for STEMI without cardiogenic shock.

Keywords: National Inpatient Database (NIS); STEMI; cardiogenic shock; culprit-only PCI; multivessel PCI.