Alejandro Lemor1, Mir B Basir2, Kirit Patel3, Brian Kolski4, Amir Kaki5, Navin K Kapur6, Robert Riley7, John Finley8, Andrew Goldsweig9, Herbert D Aronow10, P Matthew Belford11, Behnam Tehrani12, Alexander G Truesdell12, David Lasorda13, Aditya Bharadwaj14, Ivan Hanson15, Thomas LaLonde5, Sarah Gorgis2, William O'Neill2. 1. Department of Cardiology, Henry Ford Hospital, Detroit, Michigan. Electronic address: alejandrolemor@outlook.com. 2. Department of Cardiology, Henry Ford Hospital, Detroit, Michigan. 3. Department of Cardiology, St. Joseph Mercy Oakland, Pontiac, Michigan. 4. Department of Cardiology, St. Joseph's Hospital-Orange, Orange, California. 5. Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan. 6. Department of Cardiology, Tufts Medical Center, Boston, Massachusetts. 7. The Christ Hospital Health Network, Cincinnati Ohio. 8. Department of Cardiology, Mercy Fitzgerald Hospital, Yeadon, Pennsylvania. 9. Department of Cardiology, University of Nebraska, Omaha, Nebraska. 10. Department of Cardiology, Alpert Medical School at Brown University, Providence, Rhode Island. 11. Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, North Carolina. 12. Department of Cardiology, Inova Fairfax Hospital, Falls Church, Virginia. 13. Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania. 14. Department of Cardiology, Loma Linda Medical Center, Loma Linda, California. 15. Department of Cardiology, Beaumont Hospital-Royal Oak, Royal Oak, Michigan.
Abstract
OBJECTIVES: This study sought to compare outcomes of patients enrolled in the NCSI (National Cardiogenic Shock Initiative) trial who were treated using a revascularization strategy of percutaneous coronary intervention (PCI) of multivessel PCI (MV-PCI) versus culprit-vessel PCI (CV-PCI). BACKGROUND: In patients with multivessel disease who present with acute myocardial infarction and cardiogenic shock (AMICS), intervening on the nonculprit vessel is controversial. There are conflicting published reports and lack of evidence, particularly in patients treated with early mechanical circulatory support (MCS). METHODS: From July 2016 to December 2019, patients who presented with AMICS to 57 participating hospitals were included in this analysis. All patients were treated using a standard shock protocol emphasizing early MCS, revascularization, and invasive hemodynamic monitoring. Patients with multivessel coronary artery disease (MVCAD) were analyzed according to whether CV-PCI or MV-PCI was undertaken during the index procedure. RESULTS: Of 198 patients with MVCAD, 126 underwent MV-PCI (64%) and 72 underwent CV-PCI (36%). Demographics between the cohorts were similar with respect to age, sex, history of diabetes, prior PCI or coronary artery bypass grafting, and prior history of myocardial infarction. Patients who underwent MV-PCI had a trend toward more severe impairment of cardiac output and worse lactate clearance on presentation, and cardiac performance was significantly worse at 12 h. However, 24 h from PCI, the hemometabolic derangements were similar. Survival and rates of acute kidney injury were not significantly different between groups (69.8% MV-PCI vs. 65.3% CV-PCI; p = 0.51; and 29.9% vs. 34.2%; p = 0.64, respectively). CONCLUSIONS: In patients with MVCAD presenting with AMICS treated with early MCS, revascularization of nonculprit lesions was associated with similar hospital survival and acute kidney injury when compared with culprit-only PCI. Selective nonculprit PCI can be safety performed in AMICS in patients supported with mechanical circulatory support.
OBJECTIVES: This study sought to compare outcomes of patients enrolled in the NCSI (National Cardiogenic Shock Initiative) trial who were treated using a revascularization strategy of percutaneous coronary intervention (PCI) of multivessel PCI (MV-PCI) versus culprit-vessel PCI (CV-PCI). BACKGROUND: In patients with multivessel disease who present with acute myocardial infarction and cardiogenic shock (AMICS), intervening on the nonculprit vessel is controversial. There are conflicting published reports and lack of evidence, particularly in patients treated with early mechanical circulatory support (MCS). METHODS: From July 2016 to December 2019, patients who presented with AMICS to 57 participating hospitals were included in this analysis. All patients were treated using a standard shock protocol emphasizing early MCS, revascularization, and invasive hemodynamic monitoring. Patients with multivessel coronary artery disease (MVCAD) were analyzed according to whether CV-PCI or MV-PCI was undertaken during the index procedure. RESULTS: Of 198 patients with MVCAD, 126 underwent MV-PCI (64%) and 72 underwent CV-PCI (36%). Demographics between the cohorts were similar with respect to age, sex, history of diabetes, prior PCI or coronary artery bypass grafting, and prior history of myocardial infarction. Patients who underwent MV-PCI had a trend toward more severe impairment of cardiac output and worse lactate clearance on presentation, and cardiac performance was significantly worse at 12 h. However, 24 h from PCI, the hemometabolic derangements were similar. Survival and rates of acute kidney injury were not significantly different between groups (69.8% MV-PCI vs. 65.3% CV-PCI; p = 0.51; and 29.9% vs. 34.2%; p = 0.64, respectively). CONCLUSIONS: In patients with MVCAD presenting with AMICS treated with early MCS, revascularization of nonculprit lesions was associated with similar hospital survival and acute kidney injury when compared with culprit-only PCI. Selective nonculprit PCI can be safety performed in AMICS in patients supported with mechanical circulatory support.
Authors: Andreas Schäfer; Ralf Westenfeld; Jan-Thorben Sieweke; Andreas Zietzer; Julian Wiora; Giulia Masiero; Carolina Sanchez Martinez; Giuseppe Tarantini; Nikos Werner Journal: Front Cardiovasc Med Date: 2021-07-09