The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Angiographic predictors of outcome in myocardial infarction patients presenting with cardiogenic shock: A CULPRIT-SHOCK angiographic substudy

DOI: 10.4244/EIJ-D-20-00139

1. Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de cardiologie (AP-HP), Paris France and Department of Cardiology, University Hospital of Bern, Bern, Switzerland, France
2. Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de cardiologie (AP-HP), Paris, France
3. Statistician unit, StatEthic, Levallois-Perret, France
4. ACTION Study Group, Unité de Recherche Clinique, Hôpital Lariboisière (AP-HP), Paris, France.
5. Heart Centre Ludwigshafen, Department of Cardiology, Germany
6. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
7. Wilheminenspital Kardiologie-Wien, Vienna, Austria
8. University medical centre Ljubljana, Ljubljana, Slovenia
9. University Heart Center Luebeck, Luebeck, Germany
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Aims: To determine the prognostic impact of pre and post-PCI TIMI Flow Grade (TIMI) and TIMI Myocardial Perfusion (TMPG) in a well-defined group of patients with cardiogenic shock due to acute myocardial infarction.
Methods and results: Patients with infarct-related cardiogenic shock randomized into the CULPRIT-SHOCK trial were included in the angiographic predictor analysis whenever their TIMI or TMPG was available in the Corelab database (96.9% of cases). A multivariable logistic regression analysis, adjusted on non-angiographic covariates, was performed to investigate if TIMI or TMPG, were independently associated with all-cause mortality or renal replacement therapy up to 1 year. Pre-PCI TIMI and TMPG did not impact mortality. When analyzed in separate multivariable models, post-PCI TIMI 3 and TMPG grade 3 were both significantly associated with reduced risk of 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 TMPG was significantly associated with 30-day mortality (aOR 0.38 [0.20-0.71], p=0.002), 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).
Conclusions: Post-PCI TIMI and TMPG are associated with mortality after PCI. TMPG is a better discriminator, supporting microcirculation rather than epicardial reperfusion for prognosis estimation.

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