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Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock

2020; Elsevier BV; Volume: 13; Issue: 10 Linguagem: Inglês

10.1016/j.jcin.2020.03.012

1936-8798

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

Cardiac Structural Anomalies and Repair

This study sought to compare outcomes of patients enrolled in the NCSI (National Cardiogenic Shock Initiative) trial who were treated using a revascularization strategy of percutaneous coronary intervention (PCI) of multivessel PCI (MV-PCI) versus culprit-vessel PCI (CV-PCI). In patients with multivessel disease who present with acute myocardial infarction and cardiogenic shock (AMICS), intervening on the nonculprit vessel is controversial. There are conflicting published reports and lack of evidence, particularly in patients treated with early mechanical circulatory support (MCS). From July 2016 to December 2019, patients who presented with AMICS to 57 participating hospitals were included in this analysis. All patients were treated using a standard shock protocol emphasizing early MCS, revascularization, and invasive hemodynamic monitoring. Patients with multivessel coronary artery disease (MVCAD) were analyzed according to whether CV-PCI or MV-PCI was undertaken during the index procedure. Of 198 patients with MVCAD, 126 underwent MV-PCI (64%) and 72 underwent CV-PCI (36%). Demographics between the cohorts were similar with respect to age, sex, history of diabetes, prior PCI or coronary artery bypass grafting, and prior history of myocardial infarction. Patients who underwent MV-PCI had a trend toward more severe impairment of cardiac output and worse lactate clearance on presentation, and cardiac performance was significantly worse at 12 h. However, 24 h from PCI, the hemometabolic derangements were similar. Survival and rates of acute kidney injury were not significantly different between groups (69.8% MV-PCI vs. 65.3% CV-PCI; p = 0.51; and 29.9% vs. 34.2%; p = 0.64, respectively). In patients with MVCAD presenting with AMICS treated with early MCS, revascularization of nonculprit lesions was associated with similar hospital survival and acute kidney injury when compared with culprit-only PCI. Selective nonculprit PCI can be safety performed in AMICS in patients supported with mechanical circulatory support.