TCT-260 Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction with Cardiogenic Shock

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: Culprit-shock established the benefit of culprit-only revascularization in acute myocardial infarction and cardiogenic shock (AMICS). Whether the use of percutaneous left ventricular assist devices (pLVAD) changes this paradigm remains unclear. Methods: This patient-level pooled analysis of RECOVER III (NCT04136392) and the National Cardiogenic Shock Initiative (NCT03677180)-both single-arm, multicenter, observational studies-enrolled patients with AMICS who underwent percutaneous coronary intervention (PCI) with pLVAD. Outcomes were compared between patients with multi-vessel (MV) disease undergoing MV PCI vs. culprit-vessel (CV) PCI. Patients who underwent left main PCI were excluded. Results: Among 369 patients with MV disease, 191 (51.8%) underwent MVPCI and 178 (48.2%) underwent CVPCI, with no significant differences in baseline characteristics. In-hospital survival was higher in patients undergoing MVPCI (63.4% vs. 52.2%, RR: 0.77 [0.60, 0.98], p=0.03). Thirty-day and 1-year survival favored MVPCI (57.7% vs. 48.2%, p=0.08, and 45.5% vs. 34.5%, p=0.059, respectively). In stage E shock, MVPCI improved in-hospital survival (54.8% vs. 39.4%, p=0.03). Notably, stage C/D had similar in-hospital survival irrespective of revascularization strategy (71.4% vs. 69.2%, p=0.75) (Table). [Formula presented] Conclusion: In patients with AMICS and MV disease treated with early pLVAD, MVPCI was associated with improved survival, especially in patients in Stage E shock. Randomized trials are needed to confirm the benefit of MVPCI in this population. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arrest

Volume

86

Issue

17

First Page

B113

Last Page

B114

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