Complete revascularization strategy in patients with cardiogenic shock due to acute myocardial infarction: insights from the REGALIAM registry

Abstract Background Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) represents a critical and life-threatening condition commonly observed in patients with multivessel coronary artery disease (CAD). Despite the rapid implementation of revascularization strategies, the mortality rate associated with AMI-related CS remains alarmingly high (1). Current evidence remains insufficient regarding the efficacy of extensive revascularization as a determinant in optimizing clinical outcomes. Purpose The aim of this study was to assess the relationship between a complete revascularization during admission and short and mid-term clinical outcomes in patients with multivessel CAD and infarct-related CS. Methods Data was collected from the Galician regional multicentric registry of AMI (REGALIAM) which included 1053 patients with AMI-related CS. Among them, 7 patients were excluded due to the absence of primary coronary intervention (PCI). Finally, 624 individuals exhibited multivessel coronary artery disease (CAD) and were stratified into two cohorts: those who underwent complete revascularization during hospitalization and those who did not. The primary outcome was the composite endpoint of major adverse cardiovascular event (MACE) at 30 days, 6 months and 1 year. MACE was defined as the composite of death from any cause, AMI, stroke, major bleeding and hospitalization because of heart failure. Multivariate Cox regression for the 30-day composite primary outcome was also performed using variables that were significantly associated in the univariate analysis. Results Among the 624 patients who were included in our study, 235 individuals (38.1%) were in the complete revascularization group and 382 (61.9%) in the other group. The median follow-up of our cohort was 27 (2-883) days with a median age of 69 years (58-78) and 463 (74.2%) were male. Patients without complete revascularization had higher rates of MACE at 30 days (52.9% vs 39.6%; p log-rank test =0.009), at 6 months (63.4% vs 48.9%; p log-rank test =0.002) and at 1 year (65.5% vs 51.5%; p log-rank test =0.002). An initial left ventricular ejection fraction (LVEF) less than 40%, elevated lactate levels or the presence of significant aortic stenosis (AS) were significantly associated with poor outcomes at 30 days. There was also a slight trend toward an association with the absence of complete final revascularization, but it was not statistically significant (HR 0.76 IC95% 0.52 – 1.10; p =0.146).. Conclusion In patients with AMI-related CS and multivessel disease, complete revascularization during the index hospitalization was not associated with lower rate of MACE.Kaplan-Meier curves of MACE at 30 days  Multivariate Cox regression