Abstract 10879: Risk of Renal Failure With Multivessel vs. Culprit-Lesion Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock: An Updated Meta-Analysis

IntroductionThere is considerable debate regarding the optimal revascularization strategy in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS), particularly regarding the management of non-culprit lesions. Although MV-PCI is thought to prevent recurrent ischemia in non-infarct related lesions, one of the major safety concerns is the risk of contrast induced renal failure from use of more contrast dye with MV-PCI.MethodsWe conducted an updated meta-analysis of studies comparing multivessel (MV-PCI) versus culprit lesion-only percutaneous coronary intervention (CL-PCI), in patients with AMI and CS. We searched PubMed, MEDLINE, CINHAL, Cochrane CENTRAL, EMBASE, Web of Science and Google Scholar databases from inception through April 30, 2018. Only studies reporting data on renal failure were included in this analysis. Renal failure was generally defined as a new requirement for renal replacement therapy at short-term follow up (In-hospital/30 days). Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using the random-effects models of DerSimonian and Laird. Statistical analysis was done in line with recommendations from the Cochrane Collaboration using Review Manager (RevMan) version 5.3ResultsA total of 8 studies (7 observational, 1 RCT) involving 6596 patients (1572 undergoing MV-PCI and 5024 undergoing CL-PCI) were included in the final analysis. Renal Failure was noted in a total of 519 (7.8 %) patients (156 in MV-PCI group and 363 in CL-PCI group). Compared to CL-PCI, there was no significant difference in the risk of renal failure with MV-PCI [9.9 % vs. 7.2 %; OR 1.19; 95% CI 0.84-1.68, p=0.3, I =52 %] (Figure).ConclusionsOur analysis suggests that MV-PCI is not associated with an increased risk of renal failure compared to CL-PCI, in patients with AMI and CS.