The risk of death or renal-replacement therapy at 30 days and at one year in patients with acute myocardial infarction (AMI) and cardiogenic shock was lower with culprit-lesion-only PCI than with immediate multi-vessel PCI, based on findings from CULPRIT-SHOCK presented Aug. 25 at ESC Congress 2018 and simultaneously published in the New England Journal of Medicine.

Investigators randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multi-vessel PCI and assessed clinical outcomes at 30 days and one year. Specific endpoints included death from any cause, recurrent MI, repeat revascularization, and rehospitalization for congestive heart failure.

At 30 days, death from any cause or renal replacement therapy occurred in 45.9 percent of patients in the culprit-lesion-only group, compared to 55.4 percent in the multi-vessel group. (These results were previously reported at TCT 2017.) At one year, death had occurred in 50 percent of patients in the culprit-lesion-only group, compared to 56.9 percent in the multi-vessel group.

Additional findings showed the rate of recurrent infarction was 1.7 percent in culprit-lesion-only patients compared with 2.1 percent in multi-vessel patients, and a composite of death or recurrent infarction was 50.9 percent compared with 58.4 percent, respectively. Study investigators did note that repeat revascularization and rehospitalization for heart failure were more frequent with patients in the culprit-lesion-only group (32.3 percent and 5.2 percent, respectively) compared with patients in the multi-vessel group (9.4 percent and 1.2 percent, respectively).

Keywords: ESC18, ESC Congress, Acute Coronary Syndrome, Shock, Cardiogenic, Shock, Percutaneous Coronary Intervention, Myocardial Infarction

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