الفهرس 
Complications of ST-elevation myocardial infarction (STEMI)¬Only 14 pages are availabe for public view
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Abstract
Background: There is marked controversy as regards the proper management approach among patients with STEMI, cardiogenic shock who show multi-vessel affection during the initial coronary angiography. A debate is present regarding culprit only versus total revascularization during the index procedure and the proper strategy needs to be readdressed.
Aim: This is an observational multicenter study that aims at assessing the best strategy for revascularization of STEMI patients with multivessel affection and cardiogenic shock excluding patients showing CTO lesions.
Methods We followed up 100 patients to either culprit-lesion-only PCI or immediate multivessel PCI. The results for the primary end point of death or renal-replacement therapy at 3 months have been reported previously. Prespecified secondary end points at 3 months included recurrent myocardial infarction, repeat revascularization, re-hospitalization for congestive heart failure, stroke, significant bleeding, the development of CIN and the amount of dye used.
Results: As reported previously, at 3 months, the all-cause mortality was much lower the total revascularization group (32% vs. 52%, P=0.043), the need for replacement therapy was higher in the total revascularization group (10% vs. 2%, P=0.204) as well as the rates of CIN (28% vs. 9%, P=0.235). The rate of recurrent infarction was higher among the culprit-only group (10% vs 2%, P=0.204) as well as the need for urgent revascularization (18% vs. 2%, P=0.008).
Conclusion: Among the selected groups of patients presetting with STEMI, cardiogenic shock and multi-vessel disease total revascularization provided better outcomes as regards 3-months mortality, recurrent infection and need for urgent re-intervention with no significant increment in the rates of CIN or renal replacement therapy.