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

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 (n(MVI) = 1,937; n(CVI )= 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; I-2 = 75.82%), long-term mortality (RR: 0.93 [0.78, 1.11]; p = 0.37; I-2 = 67.92%), reinfarction (RR: 1.16 [0.75, 1.79]; p = 0.50; I-2 = 0%), revascularization (RR: 0.84 [0.48, 1.47]; p = 0.54; I-2 = 83.01 %), bleeding (RR: 1.15 [0.96, 1.38]; p = 0.09, I-2 = 0%), or stroke (RR: 1.29 [0.86, 1.94]; p = 0.80, I-2 = 0%). However, significantly increased risk of renal failure was seen in the MVI group (RR: 1.35 [1.10, 1.66]; p = 0.004; 1 2 = 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. (C) 2018 Elsevier Inc. All rights reserved.