CULPRIT-SHOCK study

Abstract

The treatment of patients with ST-segment elevation myocardial infarction concomitant with the presence of multivessel disease has been studied in several recent studies with the purpose of defining the need, as well as the best moment to approach residual lesions. However, such studies included only stable patients. The best therapeutic approach to cardiogenic shock secondary to acute coronary syndrome, however, remains controversial, but there are recommendations from specialists for revascularization that include nonevent related injuries. Recently published, the CULPRIT-SHOCK study showed benefit of the initial approach only of the injury blamed for the acute event, in view of the multivessel percutaneous intervention, in the context of cardiogenic shock. In this perspective, the authors discuss the work in question, regarding methodological questions, limitations and clinical applicability.

Nomogram for Predicting In-Hospital Mortality in Patients with Acute ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock after Primary Percutaneous Coronary Intervention

“…However, they did not include patients with a cardiogenic shock, leaving a gap of evidence. In the CULPRIT SHOCK trial [36], the investigators observed that in STEMI-CS patients, revascularization of the culprit vessel alone reduced all-cause mortality and incidence of renal insufficiency within 30 days, possibly related to increased contrast agent dosage and fluoroscopy time, which increased inflammatory activity and had harmful effects on the heart muscle. In the future, we may develop related randomized trials to discuss the impact of complete and incomplete revascularization on the in-hospital mortality of STEMI patients with CS after PCI.…”