Cardiogenic shock at admission in patients with multivessel disease and acute myocardial infarction treated with percutaneous coronary intervention: Related factors César Conde-Vela, Raúl Moreno ⁎ , Rosana Hernández, María J. Pérez-Vizcayno, Fernando Alfonso, Javier Escaned, Manel Sabaté, Camino Bañuelos, Carlos Macaya Division of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain Received 10 July 2006; accepted 9 November 2006 Available online 15 February 2007 Abstract Background: Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), those with multivessel disease have worse prognosis, mainly due to a higher frequency of cardiogenic shock (CS) at admission. The aim of this study was to identify clinical and angiographic characteristics of patients with STEMI, multivessel disease and CS at admission referred to primary PCI. Methods: We studied 630 patients with STEMI treated with primary PCI within 12 h after symptoms onset. Multivessel disease was defined as the presence of ≥ 50% stenosis in ≥ 2 major epicardial arteries. Multivessel disease was documented in 276 patients (44%), these patients comprising the study population. Clinical, angiographic and procedural variables were compared between those with and without CS. A logistic regression analysis was performed to identify the independent predictors of CS among patients with multivessel disease. Results: Among patients with multivessel disease, 45 (16%) had CS at admission. The independent predictors of CS in patients with multivessel disease were: STEMI anterior [OR 2.05; 95% CI 1.0 to 4.1; p = 0.044], female gender [odds ratio (OR) 2.49; 95% confidence intervals (CI) 1.1 to 5.3; p = 0.021], proximal culprit lesion [OR 3.8; 95% CI 1.7 to 8.5; p b 0.001], and chronic occlusion of other coronary arteries [OR 4.48; 95% CI 2.1 to 9.1; p b 0.001]. Conclusions: Among patients with STEMI and multivessel disease, CS is especially frequent in STEMI anterior, female gender, proximal culprit lesion, and chronic occlusion of other vessels. © 2007 Published by Elsevier Ireland Ltd. Keywords: Acute myocardial infarction; Multivessel disease; Cardiogenic shock 1. Introduction Cardiogenic shock (CS) is a serious complication and the leading cause of in-hospital mortality in patients with ST- segment elevation myocardial infarction (STEMI). It affects approximately to 7–10% of patients with STEMI, and occurs mainly within the 48 h after symptoms onset [1,2]. In these patients, a strategy of early revascularization is associated with better outcomes than intensive medical therapy [3–5], but mortality rate remains very high (N 50%) [6–8]. Multivessel disease is present in 40–60% of patients with STEMI referred to primary percutaneous coronary interven- tion (PCI). These patients have worse prognosis, with a worse clinical outcome mainly due to a higher frequency of CS at admission [9–12]. The aim of this study was to identify International Journal of Cardiology 123 (2007) 29 – 33 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Division of Interventional Cardiology, Hospital Clínico San Carlos, Prof. Martín Lagos, s/n. 28040, Madrid, Spain. Tel.: +34 91 330 3283; fax: +34 91 330 3289. E-mail address: raulmoreno@terra.es (R. Moreno). 0167-5273/$ - see front matter © 2007 Published by Elsevier Ireland Ltd. doi:10.1016/j.ijcard.2006.11.102