Less Is Still More in Patients with Acute Myocardial Infarction and Cardiogenic Shock

Despite major advances in reperfusion therapy, patients with cardiogenic shock and acute myocardial infarction (AMI) continue to represent a high-risk group, with early mortality rates approaching 50% to 60%. As most of these patients have multivessel coronary artery disease, current guidelines recommend early and complete revascularization of both the culprit lesion and nonculprit lesions. Recently, however, the randomized CULPRIT-SHOCK trial — involving 706 AMI patients with cardiogenic shock — demonstrated that at 30 days, culprit-lesion-only percutaneous coronary intervention, compared with immediate and complete revascularization, led to lower rates of death (43% vs. 52%; relative risk [RR], 0.83) and the composite of death or renal-re…