Culprit-Vessel Versus Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: Insights From the National Cardiogenic Shock Initiative
Lemor A, Basir M, Patel K, Salam M, Schreiber T, Kaki A, Jain T, Hanson I, Almany S, Timmis S, Dixon S, Kolski B, Todd J, Senter S, Marso S, Lasorda D, Wilkins C, Lalonde T, Attallah A, Larkin T, Dupont A, Marshall J, Patel N, Green M, Tehrani B, Truesdell A, Sharma R, Akhtar Y, O'Neill B, Finley J, Rahman A, Foster M, Askari R, Goldsweig A, Martin S, Bharadwaj A, Khuddus M, Caputo C, Korpas D, Cawich I, Kapur N, McAllister D, Blank N, Alraies MC, Fisher R, Khandelwal A, Alaswad K, Johnson T, Hacala M, and O'Neill W. Culprit-Vessel Versus Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: Insights From the National Cardiogenic Shock Initiative. J Am Coll Cardiol 2019; 74(13):B796.
J Am Coll Cardiol
Background: The National Cardiogenic Shock Initiative (NCSI) is a single-arm, prospective, multicenter study to assess clinical outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI). We aim to determine if patients with AMICS with MCS benefit from culprit versus multivessel PCI. Methods: From July 2016 to February 2019, patients who presented with AMICS to the 35 participating hospitals were included in the study and were treated using a standard protocol with invasive hemodynamic monitoring, early MCS, and PCI. Patients with multivessel coronary artery disease (MVCAD) were analyzed on the basis of culprit-only PCI (CV-PCI) versus multivessel PCI (MV-PCI). Results: Among 171 patients included in the NCSI, 108 had MVCAD, of whom 69 underwent MV-PCI (64%) and 39 CV-PCI (36%). The mean ages were 64.8 years for the MV-PCI group and 63.2 years for the CV-PCI group; in both groups, the majority were men (81.2% and 79.5%). Patients who underwent MV-PCI had higher frequencies of diabetes (44.6% vs. 40.5%), heart failure (34.4% vs. 22.2%), prior myocardial infarction (24.2% vs. 15.8%), and prior stroke (14.1% vs. 5.4%) and a lower frequency of chronic kidney disease (12.3% vs. 18.4%) compared with those who underwent CV-PCI. In-hospital mortality was not significantly different between groups (29% for MV-PCI vs. 25.6% for CV-PCI; p = 0.824), as well as the rate of acute kidney injury (AKI) (65.1% vs. 61.1%; p = 0.828). Conclusion: Among patients with AMICS supported with MCS, the in-hospital mortality and incidence of AKI were not significantly different if they underwent multivessel or culprit vessel PCI. Further randomized controlled trials are needed to evaluate multivessel versus culprit vessel PCI in cardiogenic shock with the use of MCS.