CULPRIT-SHOCK

2018 Cardiology

83 ICUs

686 patients

In patients with acute myocardial infarction and cardiogenic shock, 30 days risk of a composite of death from any cause or renal-replacement therapy was significantly lower with culprit-lesion-only PCI than with multi-vessel PCI The mortality difference was not significant at 1 year but the incidence of rehospitalisation for heart failure was higher and repeat revascularisation was more frequent with culprit-lesion-only PCI than with multi-vessel PCI

Clinical Question

In patients with acute myocardial infarction complicated by cardiogenic
shock and evidence of multi-vessel disease on early diagnostic angiography,
does immediate multi-vessel percutaneous coronary intervention (PCI)
compared to culprit lesion only PCI (with staged revascularisation) improve
outcome?

Critical Appraisal

Critique

Open label. Power for 30 day analysis only. 43 patients crossed over to multi-vessel PCI

Population: AMI
Population Details: Multivessel Coronary Artery Disease
Intervention Arms: Culprit-lesion only
Culprit-lesion treated first
All other lesions left untreated at time of initial procedure
Further staged revascularisation was recommended on the basis of patient’s clinical status and the presence of residual ischaemia on object testing
Control Arms: Multi-vessel
Culprit-lesion treated first
All other major coronary arteries with >70% stenosis of diameter (including chronic occlusions) treated
Primary Outcome: Composite mortality and renal failure
Secondary Outcomes: No difference in mortality at 1 year
P Value: 0.01

Outcome Results

Not recorded

Primary location: Europe Landmark trial