Thiele et al report the results of the culpritshock trial doi. Hochman, md, facc, and stuart katz, md, facc, note that despite major advances in pci technique and antithrombotic pharmacology during the approximately 20 years between the shock trial and the culpritshock trial, 30day mortality among patients who underwent initial culpritlesion only pci was nearly. In patients with stemi and cgs, early revascularisation of the culprit artery improves outcomes. Culprit lesiononly pci improves outcomes for cardiogenic. Patients with cardiogenic shock cs presenting with stemi still have high mortality rates. Holger thiele, md, at tct 2017 published simultaneously online at, percutaneous coronary intervention pci of the culprit lesion only is associated with a lower 30day composite risk for severe renal failure or death compared with multivessel pci in patients with multivessel disease, cardiogenic shock cs, and acute. Published in 1999, in a sample with 302 patients, the shock trial evaluated the best therapeutic approach in cardiogenic shock secondary to stemi. Trial design the present report is a secondary analysis of the multicenter randomized culpritshock trial. Integrating the results of the culpritshock trial in the.
According to findings from a multicenter trial presented by dr. Prognostic impact of nonculprit chronic total occlusions in infarctrelated cardiogenic shock. A multicentre randomised controlled trial, culpritshock, is examining whether culprit vessel only pci with potentially subsequent staged revascularisation is more effective than immediate multivessel pci. Denver october 30, 2017 results from the prospective, randomized, multicenter culpritshock trial found that an initial strategy of culprit lesion only percutaneous coronary intervention pci reduces the composite of 30day mortality andor severe renal failure in patients with multivessel. Crt group foundation is a not for profit corporation dedicated to providing educational services in the field of cardiology through the website, and the cardiovascular research technologies crt annual symposium. Crf is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. The culprit shock trial will address the question of optimal revascularization strategy in patients with multivessel disease and acute myocardial infarction complicated by cs. The should we emergently revascularize occluded coronaries for cardiogenic shock shock trial randomly assigned 302 patients with predominant left ventricular failure following an acute myocardial infarction to a strategy of emergency revascularization or initial medical stabilization. Abstract background in patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention pci improves outcomes. Open access protocol protocol for an economic evaluation. Oneyear outcomes after pci strategies in cardiogenic shock. Restricting inclusion to patients with medicare claims data i.
Revascularisation and mechanical circulatory support in. However, in the presence of cardiogenic shock, the optimal management strategy for additional nonculprit lesions is unknown. This study aimed to assess the trends in management of cs patients with multivessel disease mvd, particularly looking at the incidence and outcomes of complete revascularisation compared to culprit vessel only. In the current subanalysis, we investigated the patients treated with an impella support device compared. P5737use of the impella mechanical support device in. Culpritlesiononly pci compared with multivessel pci is. In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies. The 30day results of the culprit lesion only pci versus multi vessel pci in cardiogenic shock culpritshock trial challenged these guidelines. The much debated question of whether to do single vessel pci vs. Update on multivessel pci versus culprit lesion only pci and on the ongoing culpritshock trial comparing culprit lesion only versus multivessel pci in cardiogenic shock.
The culpritshock study is a 706patient controlled, international, multicenter, randomized, openlabel trial. The study has limitations inherent to its registry design. Generally, established criteria for cs definition are as follows. Culprit fishing lures is a top selling brand of lures that have been helping fishermen catch more and bigger fish for over 40 years. However, the majority of patients with cardiogenic.
The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of mv in this specific highrisk population. Culpritshock trial challenges routine multivessel pci in. Gershlick, mbbs, jamal nasir khan, mb chb, damian j. It is designed to compare culprit lesion only percutaneous coronary intervention pci with possible staged nonculprit lesion revascularization versus immediate multivessel pci in patients with cs complicating acute myocardial infarction. Tctmd is produced by the cardiovascular research foundation crf. Thiele, noting that, this led to a downgrading of immediate multivessel pci in patients with cardiogenic shock in the 2018. The trial will recruit 706 patients with ami with cardiogenic shock and multivessel disease, half. The culpritshock clinical trial randomized 706 patients with multivessel disease and cardiogenic shock to either culprit lesiononly pci, with the option of staged revascularization, or immediate multivessel pci. Protocol for an economic evaluation of the randomised. Outcomes associated with respiratory failure for patients. Culpritshock trial was an investigatorinitiated, multicenter, randomized, openlabel, multicenter trial that compared culpritlesiononly pci with optional staged revascularization with immediate multivessel pci in patients who had acute myocardial infarction that was complicated by cardiogenic shock. Multivessel versus culprit lesion only percutaneous revascularization plus potential staged revascularization in patients with acute myocardial infarction complicated by cardiogenic shock.
In this multicentre trial, 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock were randomly assigned to one of two initial revascularisation strategies. Their lures are designed for fishermen by fishermen and the companys motto is confidence with every cast. Limitations include lack of evaluation of nonculpritlesion pcis performed during the index pci, no enrollment of patients with cardiogenic shock, and the high rate. Benefit persists for culpritlesiononly pci in mi with shock. Denver in findings that challenge current guidelines, the culpritshock trial concluded that patients with acute myocardial infarction complicated by cardiogenic shock had significantly better outcomes when only the culprit lesion was treated. Cardiogenic shock culprit shock trial was designed to test the hypothesis that pci of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, would result. Culpritshock culprit lesion only pci versus multivessel pci in cardiogenic shock randomized clinical trial. Trial design the present report is a secondary analysis of the multicenter randomized culprit shock trial.
Shock trial is provided in the supple mentary appendix, available at. Culpritonly or multivessel pci in cardiogenic shock myocardial. The design details including inclusion and exclusion criteria. The culpritshock shock trial included 686 patients with ami complicated by cardiogenic shock and multivessel coronary artery disease treated with early pci.
Multivessel versus culprit lesion only percutaneous. Stemi without cardiogenic shock, multivessel pci mvpci compared with culprit vesselonly pci. The 30day results of culpritshock, published last year, demonstrated that the composite endpoint of death or severe renal failure leading to renalreplacement therapy was lower with pci of the culprit lesion only than with immediate multivessel pci,2 says dr. The trial randomized 706 patients with multivessel cad and acute stsegmentelevation mi stemi or nonstemi with shock to culpritlesion only. The results of the culpritshock culprit lesion only pci versus multivessel pci in cardiogenic shock trial, which was a rct to assess whether pci of the culprit lesion only with the option of staged revascularization of nonculprit lesions would confer better clinical outcomes when compared with immediate mv pci among patients who have mv cad. Recently published, the culpritshock study showed benefit of the initial approach. Oneyear followup of the culpritshock trial shows the advantage conferred by pci only of the culprit lesion vs immediate multivessel pci at 30 days persists in mi complicated by cardiogenic shock. The culpritshock trial is the largest rct in cardiogenic shock complicating myocardial infarction 62% stemi to date comparing iraonly pci with immediate pci of all severe lesions. Patients were randomized to immediate multivessel pci or culprit lesion only pci. Trial followup nn nn relative risk mortality 95% ci relative risk 95% ci revascularization shock 1 year 81152 100150 0. The culpritshock trial helps in determining the optimal pci strategy, but it does not move the ball forward in the big picture of this population. Based on these 30day results, culprit vessel only pci reduces mortality or severe. Cardiogenic shock culpritshock trial was designed to test the hypothesis that pci of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, would result.
The primary efficacy endpoint was 30day mortality or severe renal failure requiring renal replacement therapy. Not only is culprit shock the largest randomized trial in cardiogenic shock, it is also the first randomized trial to assess a strategy of multivessel pci versus culprit vessel only pci with the option of staged revascularization in this patient population. The culpritshock clinical trial randomized 706 patients with multivessel disease and cardiogenic shock to either culprit lesion only pci, with the option of staged revascularization, or immediate. Culpritshock study is a prospective, randomised, openlabel trial in patients with multivessel coronary artery disease and ami including both stelevation and nonstelevation myocardial infarction complicated by cardiogenic shock. Patients with cs complicating ami and multivessel coronary artery disease from the culpritshock trial were included. Munich, germanylonger followup in the culpritshock trial reinforces the advantage of culpritonly pci, with the option for staged. Culprit shock culprit lesion only pci versus multivessel pci in cardiogenic shock randomized clinical trial. The culpritshock trial will address the question of optimal revascularization strategy in patients with multivessel disease and acute myocardial infarction complicated by cs. Complete versus culprit only revascularisation in patients. Should patients with cardiogenic shock receive culprit.
This study demonstrated the risk of a composite of death from any cause or severe renal failure leading to renalreplacement therapy was lower with culpritlesiononly pci. In the most recent iabp shock ii trial, a clinical definition was used 20. Shock culprit lesion only pci versus multivessel pci in cardiogenic shock trial nct01927549 15 will shed more light on this issue. Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. Cardiogenic shock is the most common cause of death for patients hospitalized with acute myocardial infarction.
Cvlprit complete versus lesiononly primary pci trial is a u. This large, multinational, randomized controlled trial provides evidence that favors complete revascularization over culpritlesion pci in patients with stemi and multivessel cad. The 30day results showed that single culprit vessel pci strategy in the setting of shock might be a better option in reducing death and severe. Perhaps the most sobering observation in culpritshock, the largest revascularization trial for cardiogenic shock to date, is that almost half of patients with ami complicated by cardiogenic shock died within 30 days of their index event. In contrast with many of the trials in stemi without cardiogenic shock, in culpritshock, staged revascularization was encouraged and was. Randomized trial of complete versus lesiononly revascularization in patients undergoing primary percutaneous coronary intervention for stemi and multivessel disease the cvlprit trial anthony h. It is designed to compare culprit lesion only percutaneous coronary intervention pci with possible staged nonculprit lesion revascularization versus immediate multivessel pci in patients with cs complicating acute. Culprit lesion only pci versus multivessel pci in cardiogenic shock 1year results. The culpritshock study was then designed to test the hypothesis that angioplasty only of the culprit lesion, with the option of staged revascularization of the residual lesions at a second moment considering functional evaluation for ffr, symptoms and neurological status, would have better outcomes than the immediate treatment of all major. The culpritshock trial provides valuable insight into the current treatment and outcomes in ami patients presenting with cardiogenic shock. Results from the prospective, randomized, multicenter culpritshock trial found that an initial strategy of culprit lesion only percutaneous coronary intervention pci reduces the.
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