BACKGROUND: The optimal percutaneous coronary intervention (PCI) strategy in ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock and multivessel disease remains uncertain.

OBJECTIVES: The aim of this study was to investigate the association between PCI strategy and outcomes in STEMI-related cardiogenic shock and multivessel disease.

METHODS: This exploratory substudy of the DanGer Shock (Danish-German Cardiogenic Shock) multicenter trial included patients with STEMI-related cardiogenic shock and multivessel disease, excluding comatose patients resuscitated from cardiac arrest. Multivessel disease was defined by ≥1 nonculprit angiographic stenosis ≥70%. Patients with an isolated left main culprit were excluded. The planned PCI strategy was registered before randomization. All analyses were performed according to as-treated PCI strategy (immediate multivessel PCI or culprit-only PCI). The primary outcome was all-cause mortality within 180 days; secondary outcomes included renal replacement therapy and acute kidney injury.

RESULTS: Of 355 patients included in the DanGer Shock trial, 221 (72%) had multivessel disease; of these, 118 (53%) were treated with culprit-only PCI and 103 (47%) with immediate multivessel PCI. The median pre-PCI SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were 28 (Q1-Q3: 22-32) and 29 (Q1-Q3: 22-34), respectively. Chronic total occlusion PCI was performed in 6 of 103 patients (6%) treated with immediate multivessel PCI. All-cause mortality was 72 (61%; 95% CI: 52%-70%) in the culprit-only group and 52 (50%; 95% CI: 41%-60%) in the immediate multivessel PCI group (adjusted OR: 0.40; 95% CI: 0.19-0.83) over a median follow-up period of 45 days (Q1-Q3: 2-180 days). Immediate multivessel PCI was not associated with the secondary outcomes. There was no interaction according to randomization allocation and PCI strategy (P = 1.00).

CONCLUSIONS: Immediate multivessel PCI was associated with 60% lower odds of all-cause mortality compared with culprit-only PCI.