Original Investigation
Influence of Culprit Lesion Intervention on Outcomes in Infarct-Related Cardiogenic Shock With Cardiac Arrest

https://doi.org/10.1016/j.jacc.2023.01.029Get rights and content
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Abstract

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)

Key Words

acute myocardial infarction
cardiac arrest
cardiogenic shock
culprit lesion PCI

Abbreviations and Acronyms

AMI
acute myocardial infarction
CA
cardiac arrest
CPR
cardiopulmonary resuscitation
CS
cardiogenic shock
LAD
left anterior descending
MCS
mechanical circulatory support
PCI
percutaneous coronary intervention
TIMI
Thrombolysis In Myocardial Infarction

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

Alexander Truesdell, MD, served as Guest Associate Editor for this paper. Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.

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