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      Comparison of Long‐Term Clinical Outcome Between Multivessel Percutaneous Coronary Intervention Versus Infarct‐Related Artery–Only Revascularization for Patients With ST‐Segment–Elevation Myocardial Infarction With Cardiogenic Shock

      research-article
      , MD, MPH, PhD 1 , , MD 2 , , MD, PhD 3 , , MD 2 , , MD 1 , , MD 1 , , MD 1 , , MD 1 , , MD, PhD 1 , , MD, PhD 1 , , MD, PhD 1 , , MD, PhD 1 , , MD, PhD 2 , , MD, PhD 4 , , MD, PhD 5 , , MD, PhD 6 , , MD, PhD 7 , , MD, PhD 2 , , MD, PhD 1 , , MD, PhD 7 , , , MD, PhD 1 , , The KAMIR Investigators
      Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
      John Wiley and Sons Inc.
      cardiogenic shock, complete revascularization, multivessel disease, outcomes, percutaneous coronary intervention, ST‐segment–elevation myocardial infarction, Percutaneous Coronary Intervention, Revascularization, Acute Coronary Syndromes

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          Abstract

          Background

          Data are limited regarding long‐term outcomes in patients with ST‐segment–elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3‐year clinical outcomes of patients with ST‐segment‐elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct‐related artery (IRA)–only PCI.

          Methods and Results

          Of 13 104 patients from the nationwide, multicenter, prospective KAMIR‐NIH (Korea Acute Myocardial Infarction Registry––National Institutes of Health) registry, we selected 659 patients with ST‐segment‐elevation myocardial infarction who had concomitant non‐IRA stenosis and presented with cardiogenic shock. The primary outcome was all‐cause death. Multivessel PCI was performed in 260 patients and IRA‐only PCI in 399 patients. At 3 years, patients in the multivessel PCI group had a lower risk of all‐cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45–0.94 [ P=0.024]), all‐cause death or MI (adjusted hazard ratio, 0.59; 95% CI, 0.41–0.84 [ P=0.004]), and non‐IRA repeat revascularization (adjusted hazard ratio, 0.23; 95% CI, 0.10–0.50 [ P<0.001]) than those in the IRA‐only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non‐IRA repeat revascularization beyond 1 year (log‐rank P=0.030 and P=0.017, respectively) than the IRA‐only PCI group.

          Conclusions

          In patients with ST‐segment‐elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all‐cause death than IRA‐only PCI at 3 years, suggesting potential benefit of non‐IRA revascularization during the index hospitalization to improve long‐term clinical outcomes.

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          Most cited references7

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          2018 ESC/EACTS Guidelines on myocardial revascularization

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            Multicenter Cohort Study of Acute Myocardial Infarction in Korea - Interim Analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry.

            The Korea Acute Myocardial Infarction Registry (KAMIR)-National Institutes of Health (NIH) registry has the aim of evaluating the clinical characteristics, management, and long-term outcomes of patients with acute myocardial infarction (AMI) in Korea.
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              Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial.

              Patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease have a worse prognosis compared with individuals with single-vessel disease. We aimed to study the clinical outcome of patients with STEMI treated with fractional flow reserve (FFR)-guided complete revascularisation versus treatment of the infarct-related artery only.
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                Author and article information

                Contributors
                myungho@chollian.net
                jyhahn@skku.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                10 December 2019
                17 December 2019
                : 8
                : 24 ( doiID: 10.1002/jah3.v8.24 )
                : e013870
                Affiliations
                [ 1 ] Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
                [ 2 ] Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
                [ 3 ] Department of Internal Medicine and Cardiovascular Center Chosun University Hospital University of Chosun College of Medicine Gwangju Korea
                [ 4 ] Department of Internal Medicine Kyungpook National University Hospital Daegu Korea
                [ 5 ] Division of Cardiology Department of Internal Medicine Chungbuk National University Hospital Cheongju Korea
                [ 6 ] Department of Internal Medicine Kyunghee University College of Medicine Seoul Korea
                [ 7 ] Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
                Author notes
                [*] [* ] Correspondence to: Myung Ho Jeong, MD, PhD, Department of Cardiology, Chonnam National University Hospital, 42 Jebong‐ro, Dong‐gu, Gwangju 61469, Republic of Korea. Email: myungho@ 123456chollian.net and Joo‐Yong Hahn, MD, PhD, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon‐ro, Gangnam‐gu, Seoul, 06351, Republic of Korea. Email: jyhahn@ 123456skku.edu
                [†]

                Dr Joo Myung Lee and Dr Rhee contributed equally to this work.

                [‡]

                A complete list of the KAMIR Investigators can be found in the Appendix.

                Article
                JAH34611 10.1161/JAHA.119.015045
                10.1161/JAHA.119.013870
                6951086
                31818215
                de2dc007-802b-4033-9f37-edf3783f0f43
                © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 09 July 2019
                : 18 October 2019
                Page count
                Figures: 3, Tables: 4, Pages: 12, Words: 7880
                Funding
                Funded by: Research of Korea Centers for Disease Control and Prevention
                Award ID: 2016‐ER6304‐01
                Categories
                Original Research
                Original Research
                Interventional Cardiology
                Custom metadata
                2.0
                jah34611
                17 December 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.7.2 mode:remove_FC converted:16.12.2019

                Cardiovascular Medicine
                cardiogenic shock,complete revascularization,multivessel disease,outcomes,percutaneous coronary intervention,st‐segment–elevation myocardial infarction,revascularization,acute coronary syndromes

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