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Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 May 25; Vol. 13 (10), pp. 1171-1178. Date of Electronic Publication: 2020 Apr 29. - Publication Year :
- 2020
-
Abstract
- 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).<br />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).<br />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.<br />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).<br />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.<br /> (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Kidney Injury etiology
Aged
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease mortality
Coronary Artery Disease physiopathology
Databases, Factual
Female
Humans
Male
Middle Aged
Myocardial Infarction diagnostic imaging
Myocardial Infarction mortality
Myocardial Infarction physiopathology
Prospective Studies
Recovery of Function
Risk Factors
Shock, Cardiogenic diagnosis
Shock, Cardiogenic mortality
Shock, Cardiogenic physiopathology
Time Factors
Treatment Outcome
United States
Coronary Artery Disease therapy
Heart-Assist Devices
Myocardial Infarction therapy
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Shock, Cardiogenic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 13
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 32360256
- Full Text :
- https://doi.org/10.1016/j.jcin.2020.03.012