Coronary interventions – Mini focus on out-of-hospital cardiac arrest and cardiogenic shock

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

EuroIntervention 2021;16:e1237-e1244. DOI: 10.4244/EIJ-D-20-00139

Pavel Overtchouk
Pavel Overtchouk1,2,3, MD; Olvier Barthélémy2, MD; Marie Hauguel-Moreau2, MD; Paul Guedeney2, MD; Stéphanie Rouanet4, MD; Michel Zeitouni2, MD; Johanne Silvain2, MD; Jean-Philippe Collet2, MD; Eric Vicaut5, MD; Uwe Zeymer6, MD; Steffen Desch7, MD; Holger Thiele7, MD; Gilles Montalescot2, MD
1. - Read Better, Paris, France; 2. Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France; 3. Department of Cardiology, University Hospital of Bern, Bern, Switzerland; 4. Statistician Unit, StatEthic, Levallois-Perret, France; 5. ACTION Study Group, Unité de Recherche Clinique, Hôpital Lariboisière (AP-HP), Paris, France; 6. Heart Centre Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany; 7. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany

Aims: The aim of this study was to determine the prognostic impact of pre- and post-PCI TIMI flow grade and TIMI myocardial perfusion grade (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 randomised into the CULPRIT-SHOCK trial were included in the angiographic predictor analysis whenever their TIMI flow grade or TMPG was available in the core lab database (96.9% of cases). A multivariable logistic regression analysis, adjusted on non-angiographic covariates, was performed to investigate whether TIMI flow grade or TMPG was independently associated with all-cause mortality or renal replacement therapy up to one year. Pre-PCI TIMI flow grade and TMPG did not impact on mortality. When analysed in separate multivariable models, post-PCI TIMI 3 flow 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), the 30-day composite of all-cause mortality and renal replacement therapy (aOR 0.34 [0.18-0.66], p=0.001) and mortality at one-year follow-up (aOR 0.46 [0.24-0.88], p=0.02).

Conclusions: Post-PCI TIMI flow grade 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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