Supplementary Materials Appendix?S1. LAD, left anterior descending artery; LCX, left circumflex artery; LV, left ventricular; RCA, right coronary artery; otherwise as in Figure?2. JAH3-8-e013870-s001.pdf (428K) PF-02575799 GUID:?F9698596-B2EE-4638-ADD9-C98B3307D3FB Abstract Background Data are limited regarding long\term outcomes in patients with ST\segmentCelevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3\year clinical outcomes of patients with ST\segment\elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct\related artery (IRA)Conly PCI. Methods and Results Of 13?104 patients from the nationwide, multicenter, prospective KAMIR\NIH (Korea Acute Myocardial Infarction RegistryCCNational Institutes of Health) registry, we selected 659 patients with ST\segment\elevation myocardial infarction who had concomitant non\IRA stenosis and presented with cardiogenic shock. The primary outcome was all\cause death. Multivessel PCI was performed in 260 patients and IRA\only PCI in 399 patients. At 3?years, patients in the multivessel PCI group had a lower risk of all\cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45C0.94 [test or MannCWhitney test, as appropriate. Cumulative incidence of events at 3?years was calculated based on Kaplan\Meier censoring estimates, and comparison of?clinical outcomes between the multivessel PCI and IRA\only PCI groups was performed with the log\rank test. For the landmark analysis, patients at risk were reset to those who were free from events at the beginning of the landmark time point, which was 1 year after the index procedure in this analysis. Sensitivity analyses were performed to adjust for confounding factors. First, a multivariable Cox regression model was used. Covariates included in the multivariable model were selected if they were significantly Rabbit Polyclonal to ATP5S different between the 2 groups or had predictive values, which are listed in Data S1. The assumption of proportionality was assessed graphically by the log\minus\log plot, and Cox proportional hazard models for all clinical outcomes satisfied the proportional hazards assumption. For the landmark analysis, a Cox proportional hazard model with the assumption of piecewise proportionality according to the landmark time point was used. Second, the propensity scoreCmatched and inverse probabilityCweighted (IPW) Cox proportional hazard regression were performed. All available covariates were included in the logistic regression model to generate propensity scores, precisely following the recommendations of analysis using propensity score.12 For the propensity score matching, a 1:1 matching process without replacements was performed by a greedy algorithm with a caliper width of 0.4 SDs, yielding 233 patients in the multivessel PCI group matched with 233 controls in the IRA\only PCI group. For the PF-02575799 IPW adjustment, inverse of propensity score was adjusted in Cox proportional hazard regression model. Balance between the 2 groups after propensity score matching or IPW adjustment was assessed by percent standardized mean differences of all covariates. Percent standardized mean differences after propensity score matching or IPW adjustment were within 10% across all matched covariates, demonstrating successful balance achievement between comparative groups (Table?S1). We established a multivariable Cox proportional hazard model to identify independent predictors of 3\year all\cause death and all\cause death PF-02575799 or MI. C\statistics with 95% CIs were calculated to validate the discriminant function of the model. Comparison of the primary outcome according to the various exploratory subgroups was followed. In all analysis, the participating centers were included as random effects. All probability values were 2\sided and values 0.05 were considered statistically significant. Results Baseline Characteristics We analyzed the 3\year clinical outcomes of 659 patients with STEMI who had cardiogenic shock and concomitant non\IRA stenosis according to the PCI strategy (260 received multivessel PCI and 399 IRA\only PCI). Follow\up to 3?years was completed in 98.9% of the total patients with a median follow\up duration of 1066?days. Baseline clinical, lesion, and procedural profiles are described in Tables?1 and ?and2.2. One third of the patients with STEMI who had multivessel disease with cardiogenic shock experienced cardiac arrest at the visit, and the proportion of the left main artery as a culprit vessel was about 10%. Second\generation drug\eluting stents were implanted in 87.9% of patients, and 26.7% received at least 1 type of hemodynamic support including intra\aortic balloon pump or percutaneous cardiopulmonary support. Of patients in the multivessel PCI group,.