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Published on: June 12, 2021
PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock
Holger Thiele1, Ibrahim Akin1, Marcus Sandri1
1From Heart Center Leipzig, University Hospital, Leipzig (H.T., M.S., S.D.), Universitätsmedizin Mannheim, Mannheim (I.A.), University Heart Center Lübeck, Lübeck (G.F., S. de Waha, R.M.-S.), German Center for Cardiovascular Research (DZHK) (G.F., S. de Waha, R.M.-S., U.L., C.S., S.B.F., S.D.) and Universitätsklinikum Charité, Campus Benjamin Franklin (U.L., C.S.), Berlin, Universitätsklinikum Würzburg, Würzburg (P.N.), Klinikum der Eberhard-Karls-Universität Tübingen, Tübingen (T. Geisler), Klinikum Links der Weser, Bremen (A.F.), Helios Klinik Erfurt, Erfurt (H.L.), Ernst-Moritz-Arndt-Universität, Greifswald (S.B.F.), Universitäres Herzzentrum Regensburg, Regensburg (L.S.M.), and Institut für Herzinfarktforschung (S. Schneider, U.Z.) and Klinikum Ludwigshafen (U.Z.), Ludwigshafen - all in Germany; Academic Medical Center, Amsterdam (J.J.P.); University Medical Center Ljubljana, Ljubljana, Slovenia (M.N., T. Goslar); Institute of Cardiology, Warsaw, Poland (J.S.); Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Vilnius University Hospital Santaros Klinikos and Faculty of Medicine, Vilnius University, Vilnius, Lithuania (P.S.); Sorbonne Université Paris 6, ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière (G.M., O.B.), and Applied Research, Technology Transfer, Industrial Collaboration, Société Par Actions Simplifiée (P.T.), Paris; Wilhelminenspital, Department of Cardiology, and Sigmund Freud University, Medical School, Vienna (K.H.); University of Bern, Inselspital, Bern, Switzerland (S. Windecker); Manzoni Hospital, Lecco, Italy (S. Savonitto); and Universitair Ziekenhuis Antwerp, Antwerp, Belgium (C.V.).
For acute myocardial infarction with cardiogenic shock, culprit-lesion-only percutaneous coronary intervention (PCI) is superior to immediate multivessel PCI. This strategy reduces the risk of death or renal failure within 30 days.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) benefit from early revascularization of the culprit artery via percutaneous coronary intervention (PCI).
- However, many patients present with multivessel disease, making the optimal PCI strategy for non-culprit lesions controversial.
Purpose of the Study:
- To compare the effectiveness of culprit-lesion-only PCI with immediate multivessel PCI in patients with AMI and CS.
Main Methods:
- A multicenter trial randomized 706 patients with multivessel disease, AMI, and CS to either culprit-lesion-only PCI with staged revascularization or immediate multivessel PCI.
- The primary endpoint was a composite of death or severe renal failure requiring renal-replacement therapy within 30 days.
Main Results:
- The culprit-lesion-only PCI group had a lower 30-day composite endpoint rate (45.9%) compared to the multivessel PCI group (55.4%), with a relative risk of 0.83 (P=0.01).
- The relative risk of death was also lower in the culprit-lesion-only PCI group (0.84, P=0.03).
- No significant differences were observed in safety endpoints like bleeding and stroke between the groups.
Conclusions:
- In patients with multivessel coronary artery disease, AMI, and CS, initial PCI of the culprit lesion only is associated with a lower 30-day risk of death or renal failure compared to immediate multivessel PCI.
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