Culprit-only versus multivessel percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock: an updated systematic review and meta-analysis
G Medina Avalos, O Saenz Lopez, O Saenz Lopez, D Casanova Campos, M A Verber Arano, V A Castillo Bringas, R R Acedo Amezquita, A Perez Perez, V Y Gomez Lopez, S Montiel Celaya, G K Gil GardunoAbstract
Background
The optimal revascularization strategy in patients presenting with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) remains uncertain. Prior studies comparing multivessel (MV) and culprit-vessel–only (CV-only) revascularization have shown inconsistent findings.
Purpose
This systematic review and meta-analysis aimed to evaluate the differences in outcomes following MV versus CV-only revascularization in patients with acute MI complicated by CS.
Methods
A systematic search of PubMed, Embase, and Cochrane Library was conducted through January 2026 to identify studies comparing MV versus CV-only percutaneous coronary intervention in patients with acute MI complicated by CS. Meta-analysis inclusion criteria followed Cochrane guidelines. Three reviewers independently extracted data and assessed study quality. Risk of bias was determined using the ROBINS-I and ROB-2 tools. We pooled dichotomous data using odds ratios (OR) to describe effect sizes, employing a Mantel-Haenszel procedure in a random-effects model, with a 95% confidence interval.
Results
We included a total of 31 studies (29 observational and 2 RCTs) comprising 220,306 patients (69.7% CV-only; 30.3% MV). Among patients with acute MI complicated by CS, no significant differences were observed between MV and CV-only PCI for: short-term mortality (OR 1.06, 95% CI 0.95–1.20; p=0.30; I²=90%); late-term mortality (OR 0.91, 95% CI 0.75–1.11; p=0.34; I²=83%); cardiac death (OR 0.84, 95% CI 0.60–1.16; p=0.29; I²=69%); MACE (OR 1.10, 95% CI 0.94–1.29; p=0.22; I²=80%); major bleeding (OR 1.13, 95% CI 0.94–1.36; p=0.20; I²=83%); reinfarction (OR 1.06, 95% CI 0.89–1.26; p=0.53; I²=0%); and heart failure rehospitalization (OR 1.40, 95% CI 0.94–2.09; p=0.10; I²=39%). However, MV-PCI was associated with a lower risk of repeat revascularization (OR 0.67, 95% CI 0.46–0.98; p=0.04; I²=78%) but a higher risk of new renal replacement therapy (OR 1.40, 95% CI 1.32–1.49; p<0.00001; I²=0%) and stroke (OR 1.18, 95% CI 1.08–1.28; p<0.0001; I²=0%).
Conclusions
Despite the limitations of predominantly observational data, this updated meta-analysis shows that MV PCI in acute MI complicating CS does not improve short- or long-term mortality compared with a CV-only strategy. Randomized trial data are needed to further clarify the safety and optimal use of complete revascularization in this high-risk population.FIGCS11For image description, please refer to the figure legend and surrounding text.FIGCSMI2For image description, please refer to the figure legend and surrounding text.