Outcomes of multivessel vs culprit lesion-only percutaneous coronary intervention in acute myocardial infarction and cardiogenic shock: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Xinyu , LI Lingya , WANG Xiaoyu , LIANG Shichu , ZHANG Junyan , CHEN Zhongxiu ,  HE Yong

Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

HE Yong, Email: heyongmd@wchscu.cn

Keywords：

Myocardial infarction; Cardiogenic shock; Multivessel coronary artery disease; Percutaneous coronary intervention; Complete revascularization; Incomplete revascularization

DOI：

10.7507/1672-2531.202503095

Video：

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Objective Compare the therapeutic effects of multivessel percutaneous coronary intervention (MV-PCI) and culprit-only revascularization strategy (C-PCI) in percutaneous coronary intervention (PCI) for patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and multivessel disease (MVD). Methods The PubMed, Embase, Cochrane Library, MEDLINE, Web of Science, CENTRAL, CNKI and WanFang Data databases were searched to collect studies comparing C-PCI vs. MV-PCI in patients with AMI and CS from inception to March 2, 2025. Methodological quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS) and the risk of bias (ROB) tool. Meta-analysis was performed using RevMan software (version 5.4.0). Results A total of 18 studies (1 randomized controlled trial, 1 post-hoc analysis of a randomized controlled trial, and 16 retrospective observational studies), enrolling 101 693 patients. The results of the observational studies showed that MV-PCI was associated with higher risk of short-term mortality (OR=1.13, 95%CI 1.01 to 1.25, P=0.03), renal replacement therapy (OR=1.41, 95%CI 1.32 to 1.50, P<0.00001), and cerebrovascular accident events (OR=1.21, 95%CI 1.10 to 1.33, P=0.0001). No significant difference was observed in long-term mortality (OR=0.93, 95%CI 0.74 to 1.16, P=0.51), recurrent myocardial infarction (OR=1.16, 95%CI 0.97 to 1.39, P=0.10), repeat revascularization events (OR=0.83, 95%CI 0.58 to 1.20, P=0.33) and bleeding event rates (OR=1.01, 95%CI 0.71 to 1.34, P=0.97) between groups. The results remained consistent after adding the only randomized trial.Conclusions In patients with AMICS and concomitant MVD, C-PCI provides comparable survival benefits to MV-PCI and is associated with a reduced risk of all-cause mortality, cerebrovascular events, and the need for renal replacement therapy.

1.	中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會. 急性心肌梗死合并心原性休克診斷和治療中國專家共識(2021). 中華心血管病雜志, 2022, 50(3): 231-242.
2.	Kohsaka S, Menon V, Lowe AM, et al. Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med, 2005, 165(14): 1643-1650.
3.	Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation, 2009, 119(9): 1211-1219.
4.	Thiele H, Ohman EM, Desch S, et al. Management of cardiogenic shock. Eur Heart J, 2015, 36(20): 1223-1230.
5.	Sanborn TA, Sleeper LA, Webb JG, et al. Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol, 2003, 42(8): 1373-1379.
6.	Webb JG, Lowe AM, Sanborn TA, et al. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol, 2003, 42(8): 1380-1386.
7.	. Wong SC, Sanborn T, Sleeper LA, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol, 2000, 36(3 Suppl A): 1077-1083.
8.	Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J, 2014, 35(37): 2541-2619.
9.	Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 appropriate use criteria for coronary revascularization in patients with acute coronary syndromes: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol, 2017, 69(5): 570-591.
10.	Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2018, 39(2): 119-177.
11.	Samsky MD, Morrow DA, Proudfoot AG, et al. Cardiogenic shock after acute myocardial infarction: a review. JAMA, 2021, 326(18): 1840-1850.
12.	Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med, 2017, 377(25): 2419-2432.
13.	Thiele H, Akin I, Sandri M, et al. One-year outcomes after PCI strategies in cardiogenic shock. N Engl J Med, 2018, 379(18): 1699-1710.
14.	Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J, 2023, 44(38): 3720-3826.
15.	Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2022, 145(3): e4-e17.
16.	Lee JM, Rhee TM, Hahn JY, et al. Multivessel percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction with cardiogenic shock. J Am Coll Cardiol, 2018, 71(8): 844-856.
17.	Lemor A, Basir MB, Patel K, et al. Multivessel versus culprit-vessel percutaneous coronary intervention in cardiogenic shock. JACC Cardiovasc Interv, 2020, 13(10): 1171-1178.
18.	Rathod KS, Koganti S, Jain AK, et al. Complete versus culprit only revascularisation in patients with cardiogenic shock complicating acute myocardial infarction: incidence and outcomes from the London Heart Attack Group. Cardiovasc Revasc Med, 2020, 21(3): 350-358.
19.	Khera R, Secemsky EA, Wang Y, et al. Revascularization practices and outcomes in patients with multivessel coronary artery disease who presented with acute myocardial infarction and cardiogenic shock in the US, 2009-2018. JAMA Intern Med, 2020, 180(10): 1317-1327.
20.	Alegria S, Marques A, Gomes AC, et al. Revascularization strategies in patients with acute myocardial infarction and cardiogenic shock: results from the portuguese registry on acute coronary syndromes. Arq Bras Cardiol, 2021, 116(5): 867-876.
21.	. Omer MA, Brilakis ES, Kennedy KF, et al. Multivessel versus culprit-vessel percuta-neous coronary intervention in patients with non-ST-segment elevation myocardial infarction and cardiogenic shock. JACC Cardiovasc Interv, 202, 14(10): 1067-1078.
22.	Smilowitz NR, Galloway AC, Ohman EM, et al. Coronary revascularization and circulatory support strategies in patients with myocardial infarction, multi-vessel coronary artery disease, and cardiogenic shock: insights from an international survey. Am Heart J, 2020, 225: 55-59.
23.	Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
24.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
25.	Mehta SR, Wood DA, Storey RF, et al. Complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med, 2019, 381(15): 1411-1421.
26.	. Mehta SR, Wang J, Wood DA, et al. Complete revascularization vs. culprit lesion-only percutaneous coronary intervention for angina-related quality of life in patients with ST-segment elevation myocardial infarction: results from the COMPLETE randomized clinical trial. JAMA Cardiol, 2022, 7(11): 1091-1099.
27.	Stone GW, Selker HP, Thiele H, et al. Relationship between infarct size and outcomes following primary PCI: patient-level analysis from 10 randomized trials. J Am Coll Cardiol, 2016, 67(14): 1674-1683.
28.	Ng VG, Lansky AJ, Meller S, et al. The prognostic importance of left ventricular function in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Eur Heart J Acute Cardiovasc Care, 2014, 3(1): 67-77.
29.	D'Ascenzo F, Bollati M, Clementi F, et al. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221, 066 patients, and 4276 thromboses. Int J Cardiol, 2013, 167(2): 575-584.
30.	Lansky AJ, Stone GW. Periprocedural myocardial infarction: prevalence, prognosis, and prevention. Circ Cardiovasc Interv, 2010, 3(6): 602-610.
31.	Bertaina M, Ferraro I, Omedè P, et al. Meta-analysis comparing complete or culprit only revascularization in patients with multivessel disease presenting with cardiogenic shock. Am J Cardiol, 2018, 122(10): 1661-1669.
32.	Basir MB, Schreiber T, Dixon S, et al. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv, 2018, 91(3): 454-461.
33.	Duan J, Shi Y, Luo G, et al. Short-term efficacy and safety of different mechanical hemodynamic support devices for cardiogenic shock or high-risk PCI: a network meta-analysis of thirty-seven trials. Shock, 2021, 55(1): 5-13.
34.	Basir MB, Lemor A, Gorgis S, et al. Early utilization of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the national cardiogenic shock initiative. J Am Heart Assoc, 2023, 12(23): e031401.
35.	Thiele H, Zeymer U, Neumann FJ, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet, 2013, 382(9905): 1638-16.
36.	Liu T, Nie X, Wu Z, et al. Can statistic adjustment of OR minimize the potential confounding bias for meta-analysis of case-control study. A secondary data analysis. BMC Med Res Methodol, 2017, 17(1): 179.

1. 中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會. 急性心肌梗死合并心原性休克診斷和治療中國專家共識(2021). 中華心血管病雜志, 2022, 50(3): 231-242.
2. Kohsaka S, Menon V, Lowe AM, et al. Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med, 2005, 165(14): 1643-1650.
3. Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation, 2009, 119(9): 1211-1219.
4. Thiele H, Ohman EM, Desch S, et al. Management of cardiogenic shock. Eur Heart J, 2015, 36(20): 1223-1230.
5. Sanborn TA, Sleeper LA, Webb JG, et al. Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol, 2003, 42(8): 1373-1379.
6. Webb JG, Lowe AM, Sanborn TA, et al. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol, 2003, 42(8): 1380-1386.
7. . Wong SC, Sanborn T, Sleeper LA, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol, 2000, 36(3 Suppl A): 1077-1083.
8. Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J, 2014, 35(37): 2541-2619.
9. Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 appropriate use criteria for coronary revascularization in patients with acute coronary syndromes: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol, 2017, 69(5): 570-591.
10. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2018, 39(2): 119-177.
11. Samsky MD, Morrow DA, Proudfoot AG, et al. Cardiogenic shock after acute myocardial infarction: a review. JAMA, 2021, 326(18): 1840-1850.
12. Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med, 2017, 377(25): 2419-2432.
13. Thiele H, Akin I, Sandri M, et al. One-year outcomes after PCI strategies in cardiogenic shock. N Engl J Med, 2018, 379(18): 1699-1710.
14. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J, 2023, 44(38): 3720-3826.
15. Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2022, 145(3): e4-e17.
16. Lee JM, Rhee TM, Hahn JY, et al. Multivessel percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction with cardiogenic shock. J Am Coll Cardiol, 2018, 71(8): 844-856.
17. Lemor A, Basir MB, Patel K, et al. Multivessel versus culprit-vessel percutaneous coronary intervention in cardiogenic shock. JACC Cardiovasc Interv, 2020, 13(10): 1171-1178.
18. Rathod KS, Koganti S, Jain AK, et al. Complete versus culprit only revascularisation in patients with cardiogenic shock complicating acute myocardial infarction: incidence and outcomes from the London Heart Attack Group. Cardiovasc Revasc Med, 2020, 21(3): 350-358.
19. Khera R, Secemsky EA, Wang Y, et al. Revascularization practices and outcomes in patients with multivessel coronary artery disease who presented with acute myocardial infarction and cardiogenic shock in the US, 2009-2018. JAMA Intern Med, 2020, 180(10): 1317-1327.
20. Alegria S, Marques A, Gomes AC, et al. Revascularization strategies in patients with acute myocardial infarction and cardiogenic shock: results from the portuguese registry on acute coronary syndromes. Arq Bras Cardiol, 2021, 116(5): 867-876.
21. . Omer MA, Brilakis ES, Kennedy KF, et al. Multivessel versus culprit-vessel percuta-neous coronary intervention in patients with non-ST-segment elevation myocardial infarction and cardiogenic shock. JACC Cardiovasc Interv, 202, 14(10): 1067-1078.
22. Smilowitz NR, Galloway AC, Ohman EM, et al. Coronary revascularization and circulatory support strategies in patients with myocardial infarction, multi-vessel coronary artery disease, and cardiogenic shock: insights from an international survey. Am Heart J, 2020, 225: 55-59.
23. Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
24. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
25. Mehta SR, Wood DA, Storey RF, et al. Complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med, 2019, 381(15): 1411-1421.
26. . Mehta SR, Wang J, Wood DA, et al. Complete revascularization vs. culprit lesion-only percutaneous coronary intervention for angina-related quality of life in patients with ST-segment elevation myocardial infarction: results from the COMPLETE randomized clinical trial. JAMA Cardiol, 2022, 7(11): 1091-1099.
27. Stone GW, Selker HP, Thiele H, et al. Relationship between infarct size and outcomes following primary PCI: patient-level analysis from 10 randomized trials. J Am Coll Cardiol, 2016, 67(14): 1674-1683.
28. Ng VG, Lansky AJ, Meller S, et al. The prognostic importance of left ventricular function in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Eur Heart J Acute Cardiovasc Care, 2014, 3(1): 67-77.
29. D'Ascenzo F, Bollati M, Clementi F, et al. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221, 066 patients, and 4276 thromboses. Int J Cardiol, 2013, 167(2): 575-584.
30. Lansky AJ, Stone GW. Periprocedural myocardial infarction: prevalence, prognosis, and prevention. Circ Cardiovasc Interv, 2010, 3(6): 602-610.
31. Bertaina M, Ferraro I, Omedè P, et al. Meta-analysis comparing complete or culprit only revascularization in patients with multivessel disease presenting with cardiogenic shock. Am J Cardiol, 2018, 122(10): 1661-1669.
32. Basir MB, Schreiber T, Dixon S, et al. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv, 2018, 91(3): 454-461.
33. Duan J, Shi Y, Luo G, et al. Short-term efficacy and safety of different mechanical hemodynamic support devices for cardiogenic shock or high-risk PCI: a network meta-analysis of thirty-seven trials. Shock, 2021, 55(1): 5-13.
34. Basir MB, Lemor A, Gorgis S, et al. Early utilization of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the national cardiogenic shock initiative. J Am Heart Assoc, 2023, 12(23): e031401.
35. Thiele H, Zeymer U, Neumann FJ, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet, 2013, 382(9905): 1638-16.
36. Liu T, Nie X, Wu Z, et al. Can statistic adjustment of OR minimize the potential confounding bias for meta-analysis of case-control study. A secondary data analysis. BMC Med Res Methodol, 2017, 17(1): 179.

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Latest ArticlesOutcomes of multivessel vs culprit lesion-only percutaneous coronary intervention in acute myocardial infarction and cardiogenic shock: a meta-analysis

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