Background: Acute coronary syndrome (ACS) with multivessel disease )MVD( and cardiogenic shock (CS) represents a higher cardiovascular risk, and revascularization strategy in such patients remains a subject of conflict.
Objectives: This work investigated total revascularization benefits and safety compared to culprit-only revascularization in ACS, MVD, and CS patients.
Patients and methods: This prospective randomized study was performed on 130 patients, aged ≥ 18 years old, both sexes, with ACS with MVD and CS and diagnosed with significant lesions (>70% stenosis in the major coronary vessel) in one or more coronary vessels. Patients were grouped into two equal groups: patients undergoing culprit revascularization in Group CR and those undergoing total revascularization in Group TR.
Results: Procedure time, the number of stents and contrast used, and left ventricular ejection fraction were significantly increased in group TR compared with group CR (P <0.001). Cardiac mortality in hospitals, at 1m, 6m, and 1y, were insignificantly different between groups. Repeat myocardial infraction (MI) /ACS at 1m, 6m, and 1y were comparable between both groups. All cause mortality, repeat MI /ACS, and revascularization at 1y were significantly decreased in group TR compared with group CR (P <0.05).
Conclusions: In ACS with MVD and CS, total revascularization is superior to culprit-only revascularization, as evidenced by better cardiac motility, lower all cause mortality, total repeat MI /ACS, and revascularization incidence.