Coronary interventions

Culprit lesion location and outcomes in patients with multivessel disease and infarct-related cardiogenic shock: a core laboratory analysis of the CULPRIT-SHOCK trial

EuroIntervention 2021;17:418-424. DOI: 10.4244/EIJ-D-20-00561

Marie Hauguel-Moreau
Marie Hauguel-Moreau1, MD; Olvier Barthélémy1, MD; Serdar Farhan2, MD; Kurt Huber3, MD; Stéphanie Rouanet4; Michel Zeitouni1, MD; Paul Guedeney1, MD; Georges Hage1, MD; Eric Vicaut5, MD, PhD; Uwe Zeymer6, MD; Steffen Desch7, MD; Holger Thiele7, MD; Gilles Montalescot1, MD, PhD
1. Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France; 2. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at mount Sinai, New York, NY, USA; 3. 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital and Sigmund Freund University, Medical School, Vienna, Austria; 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 am Rhein, Germany; 7. Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany

Background: Critical culprit lesion locations (CCLL) such as left main (LM) and proximal left anterior descending (LAD) are associated with worse clinical outcome in myocardial infarction without cardiogenic shock (CS).

Aims: We aimed to assess whether CCLL identify a subgroup of patients with poorer prognosis when presenting with CS.

Methods: In the CULPRIT-SHOCK trial, a core laboratory reviewed all coronary angiograms to identify CCLL. A CCLL was defined as a culprit lesion with a >70% diameter stenosis of the LM, LM equivalent (>70% diameter stenosis of both proximal LAD and proximal circumflex), proximal LAD or last remaining vessel. We evaluated the primary study endpoint of the CULPRIT-SHOCK trial according to CCLL.

Results: A total of 269 (43%) out of 626 patients eligible for this analysis had a CCLL. Death or renal replacement therapy within 30 days, death within 30 days and death within one year were significantly higher in the CCLL than in the non-CCLL group (58.4% vs 43.4%, p<0.001, 55.8% vs 39.5%, p<0.001, 61.0% vs 44.5%, p<0.001, respectively). This was consistent after adjustment for baseline and angiographic characteristics. No interaction with the randomisation group (culprit lesion-only or immediate multivessel PCI) was found.

Conclusions: CCLL is frequent in CS and independently associated with worse clinical outcomes irrespective of the revascularisation strategy. Trial registration: www.clinicaltrials.gov NCT01927549

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 PCRonline.com

cardiogenic shockmultiple vessel diseasemyocardial infarction
Coronary interventionsInterventions for heart failureSTEMIStents and scaffoldsLeft main and multivessel diseaseAcute heart failure
Read next article
Feasibility and efficacy of an ultra-short side branch-dedicated balloon in coronary bifurcation stenting

Latest news