Abstract
Byline: Gauravpal S Gill, Creighton Univ SOM, Omaha, NE; Jorge Sanz Sanchez, Spain; Waiel Abusnina, Creighton Univ, Omaha, NE; Arun K Kanmanthareddy, CHI Health Clinic Cardiology, Omaha, NE; Hector Garcia-Garcia, MedStar, Washington, DC Background: Studies investigating mortality and adverse event outcomes in patients presenting with acute myocardial infarction (MI) in cardiogenic shock (CS) have reported conflicting results, and have primarily included patients with ST elevation MI. This meta-analysis investigates appropriate revascularization strategy in these patients. Methods: PubMed, Google Scholar, CINAHL and Cochrane databases were queried for studies comparing multivessel (MV) percutaneous coronary intervention (PCI) and culprit vessel (CV) PCI in patients with MI in CS. Data on outcomes from the selected studies were extracted and analyzed by means of random effects model. Two tailed p-value less than 0.05 was considered significant. Heterogeneity was assessed using I2 test. Results: Twelve studies were included in the final analysis. There was no significant difference in short-term (OR 0.95, 95% CI [0.90-1.01]; p=0.09) or long-term (1.16 [0.95-1.41]; p=0.14) mortality between MV PCI and CV PCI (Figure). Similarly, the odds of reinfarction (1.04 [0.58-1.85]; p=0.90) and stroke (1.08 [0.88-1.33]; p=0.46) were similar between the two groups. Although patients with MV PCI had lower odds of revascularization (0.46 [0.34-0.62]; p<0.01), they carried higher odds of new renal replacement therapy (1.30 [1.14-1.48]; p<0.01) and bleeding (1.25 [1.14-1.36]; p<0.01). Interestingly, on exclusion of study exclusively containing patients with non-ST elevation MI, odds of short-term mortality were higher (1.44 [1.28-1.62]; p<0.01) in the MV PCI group. Conclusions: Among patients with AMI and cardiogenic shock, there was no difference observed in short-term or long-term all-cause mortality, between MV PCI and CV PCI revascularization strategies. However, adopting the MV PCI strategy may lead to higher odds of bleeding and renal replacement therapy.