Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock

Lemor, Alejandro; Basir, Mir B.; O’Neill, William W.; Patel, Kirit; Kolski, Brian; Schreiber, Theodore; Kaki, Amir; Tehrani, Behnam; Truesdell, Alexander G.; Lasorda, David; Bharadwaj, Aditya; Almany, Steve; Timmis, Steven B.H.; Dixon, Simon; LaLonde, Thomas; Attallah, Antonious; Todd, Josh; Wilkins, Charles E.; Patel, Nainesh C; Senter, Shaun; McRae, Thomas; Rahman, Ayaz; Gelormini, Joseph; Kapur, Navin K.; Singh, Inder; Riley, Robert F.; O’Neill, Brian; Overly, Tijuan; Sharma, Rahul; Dupont, Allison; Green, Michael; Lim, Michael; Khuddus, Matheen; Caputo, Christopher; Larkin, Timothy J.; Askari, Raza; Marso, Steve; Nsair, Ali; Akhtar, Yasir; Hanson, Ivan; Lin, Lang; McAllister, David; Finley, John; Goldsweig, Andrew M.; Park, James; Gorwara, Simon; Nazir, Raja; Martin, Scott; Foster, Malcolm; Smith, Craig S.; Rangaswamy, Chandhiran; Zuberi, Omer; Federici, Robert; Baker, John E.; Cawich, Ian; Korpas, Denes; Srivastava, Nalin; Aronow, Herbert D.; Schaeffer, M.; Wohns, David; Belford, P. Matthew; Mehra, Aditya; Blank, Nimrod; Alraies, M. Chadi; Ashbrook, Michael; Abdel-Hafez, Osama; Khandelwal, Akshay; Alaswad, Khaldoon; Gorgis, Sarah; Johnson, Tyrell; Hacala, Michael

doi:10.1016/j.jcin.2020.03.012

Cited by 31 publications

(10 citation statements)

References 18 publications

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“…Recently, the American National Shock Initiative Investigators reported that in their experience multi-vessel PCI in AMI-CS was safe, when patients had been supported with an Impella microaxial flow-pump to rapidly stabilise haemodynamics (23). On first sight, theirs and our results appear to be in contradiction to the randomised CULPRIT-SHOCK trial, in which mortality was even higher when multivessel compared to culprit lesion only PCI was attempted (22).…”

Section: Discussioncontrasting

confidence: 58%

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Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality

Schäfer

Westenfeld

Sieweke

et al. 2021

Front. Cardiovasc. Med.

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Background: Acute myocardial infarction-related cardiogenic shock (AMI-CS) still has high likelihood of in-hospital mortality. The only trial evidence currently available for the intra-aortic balloon pump showed no benefit of its routine use in AMI-CS. While a potential benefit of complete revascularisation has been suggested in urgent revascularisation, the CULPRIT-SHOCK trial demonstrated no benefit of multivessel compared to culprit-lesion only revascularisation in AMI-CS. However, mechanical circulatory support was only used in a minority of patients.Objectives: We hypothesised that more complete revascularisation facilitated by Impella support is related to lower mortality in AMI-CS patients.Methods: We analysed data from 202 consecutive Impella-treated AMI-CS patients at four European high-volume shock centres (age 66 ± 11 years, 83% male). Forty-seven percentage (n = 94) had cardiac arrest before Impella implantation. Revascularisation was categorised as incomplete if residual SYNTAX-score (rS) was >8.Results: Overall 30-day mortality was 47%. Mortality was higher when Impella was implanted post-PCI (Impella-post-PCI: 57%, Impella-pre-PCI: 38%, p = 0.0053) and if revascularisation was incomplete (rS ≤ 8: 37%, rS > 8: 56%, p = 0.0099). Patients with both pre-PCI Impella implantation and complete revascularisation had significantly lower mortality (33%) than those with incomplete revascularisation and implantation post PCI (72%, p < 0.001).Conclusions: Our retrospective analysis suggests that complete revascularisation supported by an Impella microaxial pump implanted prior to PCI is associated with lower mortality than incomplete revascularisation in patients with AMI-CS.

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Section: Discussioncontrasting

confidence: 58%

“…revascularisation on Impella support. In 198 patients with multivessel disease presenting with AMI-CS, revascularization of non-culprit lesions was associated with similar survival compared with culprit-only PCI (23).…”

Section: Introductionmentioning

confidence: 95%

Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality

Schäfer

Westenfeld

Sieweke

et al. 2021

Front. Cardiovasc. Med.

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show abstract

“…To date, this has been reported more commonly in the setting of ST-elevation myocardial infarction [17][18][19] although recent large, observational studies reported by Rathod et al and Kim et al show similar findings in nonÀST-elevation myocardial infarction patient populations. 20,21 In the setting of acute myocardial infarction complicated by cardiogenic shock, evidence points to similar early outcomes after PCI regardless of whether a culprit-lesion-only or complete revascularization strategy is pursued [22][23][24] although whether these strategies yield different long-term outcomes has not been sufficiently explored.…”

Section: Discussionmentioning

confidence: 99%

Ejection Fraction Improvement Following Contemporary High-Risk Percutaneous Coronary Intervention: RESTORE EF Study Results

Wollmuth

Patel

Dahle

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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“…Of note, only 28% of patients in the CULPRIT SHOCK received MCS. Recent data from the NCSI regarding patients with multivessel disease presenting with acute MI and receiving early MCS, showed that intervening on the non-culprit lesions was safe and associated with comparable rate of death and acute kidney injury to patients who received PCI of the culprit-lesion only [27]. Interestingly, this data suggested that in patients presenting with non-ST-segment elevation MI (NSTEMI) with multi-vessel disease and CS, revascularisation of the non-culprit lesions was associated with a lower risk of in-hospital mortality but a higher risk of bleeding and need for renal replacement therapy [28].…”

Section: Revascularisation In Csmentioning

confidence: 99%

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Al‐Atta¹,

Zaidan²,

Abdalwahab³

et al. 2022

Rev. Cardiovasc. Med.

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Patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) have poor prognosis. Over the last two decades, there has been some improvement in mortality rates associated with CS. Initial measures to stabilise patients should follow a shock protocol, including therapies such as volume expansion, inotropes/vasopressors, and early coronary revascularisation. The use of mechanical circulatory support (MCS) devices demonstrated better haemodynamic and metabolic profiles for patients with CS. However, these benefits have not been consistently translated into significant reductions in cardiovascular adverse events. This review aims to discuss emerging concepts related to CS including an update on its classification and pathophysiology. The focus is on recent evidence regarding the use of MCS and the timing of initiating in patients with CS.

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Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock

Cited by 31 publications

References 18 publications

Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality

Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality

Ejection Fraction Improvement Following Contemporary High-Risk Percutaneous Coronary Intervention: RESTORE EF Study Results

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

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