Percutaneous Coronary Intervention in Multivessel Disease and Infarct-Related Cardiogenic Shock: A DanGer Shock Substudy
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| Název: | Percutaneous Coronary Intervention in Multivessel Disease and Infarct-Related Cardiogenic Shock: A DanGer Shock Substudy |
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| Autoři: | Marquard, Jasmine M., Beske, Rasmus P., Hassager, Christian, Jensen, Lisette O., Eiskjær, Hans, Mangner, Norman, Polzin, Amin, Schulze, Christian, Skurk, Carsten, Nordbeck, Peter, Panoulas, Vasileios, Zimmer, Sebastian, Schäfer, Andreas, Werner, Nikos, Holmvang, Lene, Lønborg, Jacob T., Udesen, Nanna Louise Junker, Schmidt, Henrik, Junker, Anders, Terkelsen, Christian J., Linke, Axel, Zako, Saif, Memisevic, Nedim, Konstantinou, Konstantinos, Schrage, Benedikt, Clemmensen, Peter, Møller, Jacob Eifer, Engstrøm, Thomas |
| Zdroj: | JACC: Cardiovascular Interventions. 18(18):2226-2237 |
| Informace o vydavateli: | Elsevier BV, 2025. |
| Rok vydání: | 2025 |
| Témata: | STEMI, cardiogenic shock, multivessel PCI, multivessel disease |
| Popis: | Background: The optimal percutaneous coronary intervention (PCI) strategy in ST-segment elevation myocardial infarction (STEMI)–related cardiogenic shock and multivessel disease remains uncertain. Objectives: The aim of this study was to investigate the association between PCI strategy and outcomes in STEMI-related cardiogenic shock and multivessel disease. Methods: This exploratory substudy of the DanGer Shock (Danish-German Cardiogenic Shock) multicenter trial included patients with STEMI-related cardiogenic shock and multivessel disease, excluding comatose patients resuscitated from cardiac arrest. Multivessel disease was defined by ≥1 nonculprit angiographic stenosis ≥70%. Patients with an isolated left main culprit were excluded. The planned PCI strategy was registered before randomization. All analyses were performed according to as-treated PCI strategy (immediate multivessel PCI or culprit-only PCI). The primary outcome was all-cause mortality within 180 days; secondary outcomes included renal replacement therapy and acute kidney injury. Results: Of 355 patients included in the DanGer Shock trial, 221 (72%) had multivessel disease; of these, 118 (53%) were treated with culprit-only PCI and 103 (47%) with immediate multivessel PCI. The median pre-PCI SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were 28 (Q1-Q3: 22-32) and 29 (Q1-Q3: 22-34), respectively. Chronic total occlusion PCI was performed in 6 of 103 patients (6%) treated with immediate multivessel PCI. All-cause mortality was 72 (61%; 95% CI: 52%-70%) in the culprit-only group and 52 (50%; 95% CI: 41%-60%) in the immediate multivessel PCI group (adjusted OR: 0.40; 95% CI: 0.19-0.83) over a median follow-up period of 45 days (Q1-Q3: 2-180 days). Immediate multivessel PCI was not associated with the secondary outcomes. There was no interaction according to randomization allocation and PCI strategy (P = 1.00). Conclusions: Immediate multivessel PCI was associated with 60% lower odds of all-cause mortality compared with culprit-only PCI. |
| Druh dokumentu: | Article |
| Jazyk: | English |
| ISSN: | 1876-7605 1936-8798 |
| DOI: | 10.1016/j.jcin.2025.07.035 |
| Přístupová URL adresa: | https://portal.findresearcher.sdu.dk/da/publications/4b8a9c97-0015-4851-ac81-403351fb6d10 |
| Přístupové číslo: | edsair.od......3062..77b3a84b8d6720af062cb56d87521d7d |
| Databáze: | OpenAIRE |
Nájsť tento článok vo Web of Science | Abstrakt: | Background: The optimal percutaneous coronary intervention (PCI) strategy in ST-segment elevation myocardial infarction (STEMI)–related cardiogenic shock and multivessel disease remains uncertain. Objectives: The aim of this study was to investigate the association between PCI strategy and outcomes in STEMI-related cardiogenic shock and multivessel disease. Methods: This exploratory substudy of the DanGer Shock (Danish-German Cardiogenic Shock) multicenter trial included patients with STEMI-related cardiogenic shock and multivessel disease, excluding comatose patients resuscitated from cardiac arrest. Multivessel disease was defined by ≥1 nonculprit angiographic stenosis ≥70%. Patients with an isolated left main culprit were excluded. The planned PCI strategy was registered before randomization. All analyses were performed according to as-treated PCI strategy (immediate multivessel PCI or culprit-only PCI). The primary outcome was all-cause mortality within 180 days; secondary outcomes included renal replacement therapy and acute kidney injury. Results: Of 355 patients included in the DanGer Shock trial, 221 (72%) had multivessel disease; of these, 118 (53%) were treated with culprit-only PCI and 103 (47%) with immediate multivessel PCI. The median pre-PCI SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were 28 (Q1-Q3: 22-32) and 29 (Q1-Q3: 22-34), respectively. Chronic total occlusion PCI was performed in 6 of 103 patients (6%) treated with immediate multivessel PCI. All-cause mortality was 72 (61%; 95% CI: 52%-70%) in the culprit-only group and 52 (50%; 95% CI: 41%-60%) in the immediate multivessel PCI group (adjusted OR: 0.40; 95% CI: 0.19-0.83) over a median follow-up period of 45 days (Q1-Q3: 2-180 days). Immediate multivessel PCI was not associated with the secondary outcomes. There was no interaction according to randomization allocation and PCI strategy (P = 1.00). Conclusions: Immediate multivessel PCI was associated with 60% lower odds of all-cause mortality compared with culprit-only PCI. |
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| ISSN: | 18767605 19368798 |
| DOI: | 10.1016/j.jcin.2025.07.035 |