Related Experiment Video
Updated: Dec 22, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock
Alejandro Lemor1, Mir B Basir1, Kirit Patel2
1Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.
Insights
In acute myocardial infarction and cardiogenic shock (AMICS) patients with multivessel disease, multivessel percutaneous coronary intervention (MV-PCI) showed similar survival and acute kidney injury rates compared to culprit-vessel PCI (CV-PCI). This suggests selective nonculprit PCI is safe with early mechanical circulatory support.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Multivessel disease in acute myocardial infarction and cardiogenic shock (AMICS) presents treatment controversies, especially with early mechanical circulatory support (MCS).
- Conflicting reports exist regarding the optimal revascularization strategy in AMICS patients with multivessel coronary artery disease (MVCAD).
Purpose of the Study:
- To compare outcomes of multivessel PCI (MV-PCI) versus culprit-vessel PCI (CV-PCI) in AMICS patients within the National Cardiogenic Shock Initiative (NCSI) trial.
- To evaluate the safety and efficacy of revascularization strategies in MVCAD patients experiencing AMICS and treated with early MCS.
Main Methods:
- Analysis of 198 MVCAD patients from the NCSI trial (July 2016-December 2019) treated with a standard shock protocol including early MCS.
- Patients were categorized into MV-PCI (n=126) or CV-PCI (n=72) groups based on the index revascularization procedure.
- Outcomes including hospital survival and acute kidney injury rates were compared between the two PCI strategies.
Main Results:
- Demographics were similar between MV-PCI and CV-PCI groups.
- Patients undergoing MV-PCI showed trends toward more severe cardiac dysfunction and slower lactate clearance initially, but hemometabolic derangements were similar at 24 hours post-PCI.
- Hospital survival rates (69.8% vs. 65.3%) and acute kidney injury rates (29.9% vs. 34.2%) were not significantly different between MV-PCI and CV-PCI groups.
Conclusions:
- In AMICS patients with MVCAD treated with early MCS, MV-PCI is associated with similar hospital survival and acute kidney injury rates compared to CV-PCI.
- Selective nonculprit lesion revascularization can be safely performed in AMICS patients supported by mechanical circulatory support.
Objectives:
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).
Background:
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).
Methods:
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.
Results:
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).
Conclusions:
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.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Acute Coronary Syndrome III: Diagnostic Studies