CULPRIT-SHOCK (original research)
Trial question
What is the role of PCI strategy of early revascularization of the culprit lesion only compared with immediate multivessel revascularization in patients with acute MI and cardiogenic shock?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
24.0% female
76.0% male
N = 686
686 patients (162 female, 524 male).
Inclusion criteria: patients who had acute ST-segment elevation or non-ST-segment elevation MI that was complicated by cardiogenic shock.
Key exclusion criteria: resuscitation for > 30 minutes, no intrinsic heart action, severe deficit in cerebral function with fixed dilated pupils, indication for primary urgent CABG, single-vessel coronary artery disease, mechanical cause of cardiogenic shock, shock with a noncardiogenic cause, massive PE.
Interventions
N=344 culprit lesion-only PCI (the use of standard interventional techniques, with the option of staged revascularization of nonculprit lesions).
N=342 multivessel PCI (recanalizing chronic total occlusions during acute phase; recommended maximum dose of contrast material was 300 mL).
Primary outcome
Death or renal replacement therapy at 30 days
45.9%
55.4%
55.4 %
41.5 %
27.7 %
13.8 %
0.0 %
Culprit lesion-only
PCI
Multivessel
PCI
Significant
decrease ▼
NNT = 10
Significant decrease in death or RRT at 30 days (45.9% vs. 55.4%; RR 0.83, 95% CI 0.71 to 0.96).
Secondary outcomes
Significant decrease in death (43.3% vs. 51.6%; RR 0.84, 95% CI 0.72 to 0.98).
Safety outcomes
No significant difference in rates of bleeding and stroke.
Conclusion
In patients who had acute ST-segment elevation or non-ST-segment elevation MI that was complicated by cardiogenic shock, culprit lesion-only PCI was superior to multivessel PCI with respect to death or RRT at 30 days.
Reference
Thiele H, Akin I, Sandri M et al. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. N Engl J Med. 2017 Dec 21;377(25):2419-2432.
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