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

As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention and external reviewers - has been published immediately upon acceptance as it was received in the last round of revision. The content of this article is the responsibility of the authors.

Please note that supplementary movies are not available online at this stage. Once a paper is published in its edited and formatted form, it will be accompanied online by any supplementary movies.

To read the full content of this article, please log in to download the PDF.

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.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

Read next article
An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group