Abstract 14725: Angiographic Predictors of Outcome With Respect to Reperfusion Success of the Culprit Artery: CULPRIT SHOCK Angiographic Substudy

Introduction:Validation lacks for the use of the TIMI Flow Grade (TFG) and TIMI Myocardial Perfusion grade (TMP) to estimate success of a percutaneous coronary intervention in shock patients with acute myocardial infarction.Hypothesis:We aimed at determining the prognostic insight of pre and post-PCI TFG and TMP in this context.Methods:CULPRIT SHOCK patients were included in the angiographic predictor analysis whenever their TFG or TMP was available in the Corelab database. A multivariable logistic regression analysis, adjusted on non-angiographic covariates, was performed to investigate if TFG or TMP separately or together, were independently associated with all-cause mortality. Results are presented as adjusted odds ratio (aOR) with 95% confidence intervals.Results:Data of 665 (96.9% of CULPRIT SHOCK study) patients were analysed. Pre-PCI TFG and TMP did not impact on mortality. When analysed in separate multivariable models, post-PCI TFG and TMP were both significantly associated with 30-day mortality: aOR 0.61 (95%CI: 0.38-0.97, p=0.037), and 0.46 (95%CI: 0.29-0.72, p<0.001), respectively. When considered in the same multivariable model, only TMP was significantly associated with 30-day mortality (adj. OR 0.38 [0.20-0.71], p=0.002) while TFG was not (p=0.51). Similarly, when included in the same multivariable model, only TMP remained associated with the 30-day composite of all-cause mortality and renal replacement therapy (aOR 0.34 [0.18-0.66], p=0.001) and mortality at 1 year follow-up (aOR 0.46 (0.24-0.88), p=0.02) while TFG was not (p=0.21 for both outcomes).Conclusions:The angiographic core laboratory post-PCI TFG and TMP parameters are associated with mortality after PCI in patients with acute myocardial infarction and cardiogenic shock. TMP appears to discriminate better the reperfusion success of PCI in terms of short- and long-term prognosis, suggesting that microcirculation matters more than the epicardial reperfusion after PCI in shock patients.