{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T13:58:04Z","timestamp":1751551084512,"version":"3.37.3"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:00Z","timestamp":1686614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/19\/73\/34690 to I.C."],"award-info":[{"award-number":["FS\/19\/73\/34690 to I.C."]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Revascularization strategy for patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease varies according to the patient\u2019s cardiogenic shock status, but assessing shock acutely can be difficult. This article examines the link between cardiogenic shock defined solely by a lactate of \u22652 mmol\/L and mortality from complete vs. culprit-only revascularization in this cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Patients presenting with STEMI, multi-vessel disease without severe left main stem stenosis and a lactate \u22652 mmol\/L between 2011 and 2021 were included. The primary endpoint was mortality at 30 days by revascularization strategy for shocked patients. Secondary endpoints were mortality at 1 year and over a median follow-up of 30 months. Four hundred and eight patients presented in shock. Mortality in the shock cohort was 27.5% at 30 days. Complete revascularization (CR) was associated with higher mortality at 30 days [odds ratio (OR) 2.1 (1.02\u20134.2), P = 0.043], 1 year [OR 2.4 (1.2\u20134.9), P = 0.01], and over 30 months follow-up [hazard ratio (HR) 2.2 (1.4\u20133.4), P &amp;lt; 0.001] compared with culprit lesion-only percutaneous coronary intervention (CLOP). Mortality was again higher in the CR group after propensity matching (P = 0.018) and inverse probability treatment weighting [HR 2.0 (1.3\u20133.0), P = 0.001]. Furthermore, explainable machine learning demonstrated that CR was behind only blood gas parameters and creatinine levels in importance for predicting 30-day mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients presenting with STEMI and multi-vessel disease in shock defined solely by a lactate of \u22652 mmol\/L, CR is associated with higher mortality than CLOP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuad062","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T05:51:25Z","timestamp":1686203485000},"page":"615-623","source":"Crossref","is-referenced-by-count":5,"title":["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"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8199-4275","authenticated-orcid":false,"given":"Alexander","family":"Tindale","sequence":"first","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Hill End Road, Harefield, UB9 6JH , UK"},{"name":"National Heart and Lung Institute, Imperial College London , Harefield Hospital, Hill End Road, UB9 6JH, London , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana","family":"Cretu","sequence":"additional","affiliation":[{"name":"College of Engineering, Design and Physical Sciences, Brunel University London , Kingston Lane, Uxbridge, UB8 3PH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongying","family":"Meng","sequence":"additional","affiliation":[{"name":"College of Engineering, Design and Physical Sciences, Brunel University London , Kingston Lane, Uxbridge, UB8 3PH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Panoulas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Hill End Road, Harefield, UB9 6JH , UK"},{"name":"National Heart and Lung Institute, Imperial College London , Harefield Hospital, Hill End Road, UB9 6JH, London , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"2023092602571992100_zuad062-B1","doi-asserted-by":"publisher","first-page":"qcad007","DOI":"10.1093\/ehjqcco\/qcad007","article-title":"Representativeness in randomised clinical trials supporting acute coronary syndrome guidelines","author":"Mas-Llado","year":"2023","journal-title":"Eur Heart J Qual Care Clin 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