Complete revascularisation is associated with higher mortality in STEMI patients with multivessel disease and shock defined by hyperlactatemia: Results from the Harefield Shock Registry incorporating explainable machine learning

• Published in: European heart journal. Acute cardiovascular care 2023-06
• Main Authors: Tindale, Alexander, Cretu, Ioana, Meng, Hongying, Panoulas, Vasileios
• Format: Article
• Language: English
• ISSN: 2048-8734
• DOI: 10.1093/ehjacc/zuad062

Revascularisation strategy for patients with STEMI and multi-vessel disease varies according to the patient's cardiogenic shock status, but assessing shock acutely can be difficult. This paper examines the link between cardiogenic shock defined solely by a lactate of ≥2 mmol/L and mortality from complete vs culprit-only revascularisation in this cohort. Patients presenting with STEMI, multi-vessel disease without severe left main stem stenosis and a lactate ≥2 mmol/L between 2011-21 were included. The primary endpoint was mortality at 30 days by revascularisation strategy for shocked patients. Secondary endpoints were mortality at 1-year and over a median follow-up of 30 months. 408 patients presented in shock. Mortality in the shock cohort was 27.5% at 30 days. Complete revascularisation was associated with higher mortality at 30 days (OR 2.1 (1.02-4.2), p = 0.043), one year (OR 2.4 (1.2-4.9), p = 0.01) and over 30 months follow-up (HR 2.2 (1.4-3.4), p