Culprit-Vessel-Only vs. Multivessel PCI for Acute MI and Cardiogenic Shock

In a study using registry data, the use of a multivessel strategy was associated with harm.

Although guidelines have recommended complete multivessel revascularization at the time of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) who present with cardiogenic shock, a recent randomized study (CULPRIT-SHOCK; NEJM JW Cardiol Jan 2018 and N Engl J Med 2017; 377:2419) demonstrated harm with this strategy, thus calling these guidelines into question. In a large cohort study using registry data, investigators compared multivessel versus culprit-vessel-only practices in 64,301 patients (mean age, 66; 32% women) with AMI and shock in 1649 U.S. hospitals.

The rate of multivessel PCI increased by 7% per year from 2009 (29%) to 2018 (44%) with wide interhospital variation (median, 33%; inter…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)