Meta-analysis Comparing Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Cardiogenic Shock

• Published in: The American journal of cardiology 2019-01, Vol.123 (2), p.218-226
• Main Authors: Khan, Muhammad Shahzeb, Siddiqi, Tariq Jamal, Usman, Muhammad Shariq, Riaz, Haris, Khan, Abdur Rahman, Murad, M. Hassan, Kalra, Ankur, Figueredo, Vincent M., Bhatt, Deepak L.
• Format: Article
• Language: English
• Subjects: Angioplasty; Arteries; Bias; Bleeding; Cerebral infarction; Confidence intervals; Coronary artery; Diabetes; Health risks; Heart attacks; Hypertension; Intervention; Meta-analysis; Mortality; Myocardial infarction; Patients; Renal failure; Risk; Sensitivity analysis; Short term; Subgroups; Systematic review
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.09.039

Cardiogenic shock (CS) after a myocardial infarction continues to be associated with high mortality. Whether percutaneous coronary intervention (PCI) of noninfarct coronary arteries (multivessel intervention [MVI]) improves outcomes in CS after acute myocardial infarction (AMI) remains controversial. MEDLINE, Cochrane CENTRAL, and Scopus databases were searched for original studies comparing MVI with culprit-vessel intervention (CVI) in AMI patients with multivessel disease and CS. Risk ratios (RRs) and 95% confidence intervals were calculated and pooled using a random effects model. Thirteen studies, consisting of 7,906 patients (nMVI = 1,937; nCVI = 5,969), were included in this meta-analysis. Overall, the MVI and CVI groups did not differ significantly in the risk of short-term mortality (RR: 1.06 [0.91, 1.23]; p = 0.45; I2 = 75.82%), long-term mortality (RR: 0.93 [0.78, 1.11]; p = 0.37; I2 = 67.92%), reinfarction (RR: 1.16 [0.75, 1.79]; p = 0.50; I2 = 0%), revascularization (RR: 0.84 [0.48, 1.47]; p = 0.54; I2 = 83.01%), bleeding (RR: 1.15 [0.96, 1.38]; p = 0.09, I2 = 0%), or stroke (RR: 1.29 [0.86, 1.94]; p = 0.80, I2 = 0%). However, significantly increased risk of renal failure was seen in the MVI group (RR: 1.35 [1.10, 1.66]; p = 0.004; I2 = 0%). On subgroup analysis, it was seen that results from retrospective studies showed higher short-term mortality in the MVI group in comparison with prospective studies (p = 0.003). The certainty in estimates is low due to the largely observational nature of the evidence. In conclusion, MVI provides no additional reduction in short- or long-term mortality in AMI patients with multivessel disease and CS. Additionally, the risk of renal failure may be higher with the use of MVI.