Thiele H, et al. - Given that percutaneous coronary intervention (PCI) of the culprit lesion only vs immediate multivessel PCI resulted in a lower risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, researchers assessed clinical outcomes at 1 year in these patients. Findings revealed a lower risk of death or renal-replacement therapy at 30 days among patients with acute myocardial infarction and cardiogenic shock who had culprit-lesion-only PCI vs immediate multivessel PCI. One-year follow-up revealed no significantly different mortality between the two groups.

Methods

• This study included 706 patients, who were randomly assigned to either culprit-lesion-only PCI or immediate multivessel PCI.
• The primary end point was death or renal-replacement therapy at 30 days, for which results have been reported previously.
• Death from any cause, recurrent myocardial infarction, repeat revascularization, rehospitalization for congestive heart failure, the composite of death or recurrent infarction, and the composite of death, recurrent infarction, or rehospitalization for heart failure were prespecified secondary end points at 1 year.

Results

• As reported previously, in 45.9% of the patients in the culprit-lesion-only PCI group and in 55.4% in the multivessel PCI group (P=0.01), the occurrence of primary end point at 30 days was reported.
• At 1 year, the occurrence of death was reported in 172 of 344 patients (50.0%) in the culprit-lesion-only PCI group and in 194 of 341 patients (56.9%) in the multivessel PCI group (relative risk, 0.88; 95% confidence interval [CI], 0.76 to 1.01).
• With culprit-lesion-only PCI and with multivessel PCI, the reported rate of recurrent infarction was 1.7% and 2.1%, respectively (relative risk, 0.85; 95% CI, 0.29 to 2.50), and the rate of a composite of death or recurrent infarction was 50.9% and 58.4%, respectively (relative risk, 0.87; 95% CI, 0.76 to 1.00).
• A more frequent occurrence of repeat revascularization was noted with culprit-lesion-only PCI vs with multivessel PCI (in 32.3% of the patients vs. 9.4%; relative risk, 3.44; 95% CI, 2.39 to 4.95), as was rehospitalization for heart failure (5.2% vs. 1.2%; relative risk, 4.46; 95% CI, 1.53 to 13.04).