Volume 25, Issue 108, February, 2021

Culprit-only versus complete non-CTO revascularization during primary percutaneous intervention in acute STEMI with cardiogenic shock

Tarek Abdelsalam^♦, Nabil Mahmoud, Mohammed Atef, Ahmed Rezq, Mostafa Elnozahi

Cardiology department, Faculty of medicine, Ainshams University, Cairo, Egypt

^♦Corresponding author
Cardiology department, Faculty of medicine, Ainshams University, Cairo, Egypt; Email: tarekibrahim1266@gmail.com

ABSTRACT

Background: There is marked controversy as regards the proper management approach among patients with STEMI, cardiogenic shock who show multi-vessel affection during the initial coronary angiography. A debate is present regarding culprit only versus total revascularization during the index procedure and the proper strategy needs to be re-addressed. Aim: This is an observational multicenter study that aims at assessing the best strategy for revascularization of STEMI patients with multivessel affection and cardiogenic shock excluding patients showing CTO lesions. Methods: We followed up 100 patients to either culprit-lesion-only PCI or immediate multivessel PCI. The results for the primary end point of death or renal-replacement therapy at 3 months have been reported previously. Prespecified secondary end points at 3 months included recurrent myocardial infarction, repeat revascularization, re-hospitalization for congestive heart failure, stroke, significant bleeding, the development of CIN and the amount of dye used. Results: As reported previously, at 3 months, the all-cause mortality was much lower the total revascularization group (32% vs. 52%, P=0.043), the need for replacement therapy was higher in the total revascularization group (10% vs. 2%, P=0.204) as well as the rates of CIN (28% vs. 9%, P=0.235). The rate of recurrent infarction was higher among the culprit-only group (10% vs 2%, P=0.204) as well as the need for urgent revascularization (18% vs. 2%, P=0.008). Conclusion: Among the selected groups of patients presetting with STEMI, cardiogenic shock and multi-vessel disease total revascularization provided better outcomes as regards 3-months mortality, recurrent infection and need for urgent re-intervention with no significant increment in the rates of CIN or renal replacement therapy.

Keywords: complete revascularization; culprit; STEMI; Primary PCI; cardiogenic shock

Medical Science, 2021, 25(108), 461-468

PDF