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Published on: June 12, 2021
Influence of Culprit Lesion Intervention on Outcomes in Infarct-Related Cardiogenic Shock With Cardiac Arrest
Uwe Zeymer1, Brunilda Alushi2, Marko Noc3
1Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
Insights
Cardiac arrest (CA) is common in patients with infarct-related cardiogenic shock (CS). While patients with CA were younger with fewer comorbidities, CA independently predicted 1-year mortality, underscoring the need for effective interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Cardiac arrest (CA) is a frequent complication in patients experiencing infarct-related cardiogenic shock (CS).
- Understanding the characteristics and outcomes of patients with CS, stratified by the presence of CA, is crucial for optimizing treatment strategies.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of patients with infarct-related CS, specifically comparing those with and without cardiac arrest.
- To evaluate the impact of culprit lesion percutaneous coronary intervention (PCI) in patients with CS, stratified by CA, within the CULPRIT-SHOCK trial and registry.
Main Methods:
- Analysis of 1,015 patients from the CULPRIT-SHOCK study, divided into groups with and without CA.
- Assessment of 30-day composite outcomes (all-cause death or severe renal failure) and 1-year mortality.
- Multivariate analysis to identify independent predictors of mortality.
Main Results:
- Over 50% of patients with CS experienced CA; these patients were younger with fewer comorbidities.
- No significant difference in 30-day composite outcomes or 1-year mortality between CA and non-CA groups.
- Cardiac arrest (CA) was identified as an independent predictor of 1-year mortality (HR: 1.27).
- Culprit lesion-only PCI demonstrated superiority over immediate multivessel PCI in both CA and non-CA patient groups.
Conclusions:
- Cardiac arrest (CA) occurs in over half of patients with infarct-related CS and is an independent predictor of long-term mortality.
- Despite younger age and fewer comorbidities, CA signifies a poorer prognosis.
- Culprit lesion-only PCI is the recommended revascularization strategy for patients with CS, irrespective of CA status.
Background:
Cardiac arrest (CA) is common in patients with infarct-related cardiogenic shock (CS).
Objectives:
The goal of this study was to identify the characteristics and outcomes of culprit lesion percutaneous coronary intervention (PCI) of patients with infarct-related CS stratified according to CA in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) randomized trial and registry.
Methods:
Patients with CS with and without CA from the CULPRIT-SHOCK study were analyzed. All-cause death or severe renal failure leading to renal replacement therapy within 30 days and 1-year death were assessed.
Results:
Among 1,015 patients, 550 (54.2%) had CA. Patients with CA were younger, more frequently male, had lower rates of peripheral artery disease, a glomerular filtration rate <30 mL/min, and left main disease, and they presented more often with clinical signs of impaired organ perfusion. The composite of all-cause death or severe renal failure within 30 days occurred in 51.2% of patients with CA vs 48.5% in non-CA patients (P = 0.39) and 1-year death in 53.8% vs 50.4% (P = 0.29), respectively. In a multivariate analysis, CA was an independent predictor of 1-year mortality (HR: 1.27; 95% CI: 1.01-1.59). In the randomized trial, culprit lesion-only PCI was superior to immediate multivessel PCI in patients both with and without CA (P for interaction = 0.6).
Conclusions:
More than 50% of patients with infarct-related CS had CA. These patients with CA were younger and had fewer comorbidities, but CA was an independent predictor of 1-year mortality. Culprit lesion-only PCI is the preferred strategy, both in patients with and without CA. (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock [CULPRIT-SHOCK]; NCT01927549).
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