Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning
Main finding · MortalityResult — go to the resultOdds ratio 2.1 CI 1.02–4.2Authors' conclusion
In patients presenting with STEMI and multi-vessel disease in shock defined solely by a lactate of ≥2 mmol/L, CR is associated with higher mortality than CLOP.
Study context
- Population
- ST-elevation myocardial infarction (STEMI) with multi-vessel disease (no severe left main stem stenosis) and shock defined by lactate ≥2 mmol/L, 2011–2021
- Participants
- 408 participants
- Exposure
- Complete revascularization vs culprit lesion-only PCI
- Outcome
- Mortality by revascularization strategy in shocked patients
- Follow-up
- 30 days
Methodological detailsregistry, propensity matching, inverse probability treatment weighting, explainable machine learning
- Registry
- Propensity matching
- Inverse probability treatment weighting
- Explainable machine learning
Main finding
Mortality
Odds ratio
2.1
CI 1.02–4.2
P = 0.043
CRvs CLOP
OR 2.1 (CI 1.02–4.2); P = 0.043
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate | P value | |
|---|---|---|---|
| Mortality · 1 year | OR 2.4 (CI 1.2–4.9) | P = 0.01 | |
| Mortality · 30 months follow-up | HR 2.2 (CI 1.4–3.4) | P < 0.001 | |
| Mortality after propensity matching and IPTWCRvs CLOPInverse probability treatment weighting | HR 2.0 (CI 1.3–3.0) | P = 0.001 | |
| 0.20.5125Ratio (log scale) |
| Outcome | P value |
|---|---|
| Mortality after propensity matching and IPTWCR vs CLOP · propensity matching | P = 0.018 |
Mortality in shock cohort (overall) · 30 days
- Mortality in the shock cohort
- 27.5%
Predictors of 30-day mortality (explainable machine learning)
- Complete revascularization (CR) was behind only blood gas parameters and creatinine levels in importance
Original publication
Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning. Eur Heart J Acute Cardiovasc Care. Published 13 June 2023. doi:10.
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