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Farhan S, Vogel B, Montalescot G, et al. Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Cardiol. 2020;5(12):1329-1337doi: 10.1001/jamacardio.2020.3377.
Farhan, S., Vogel, B., Montalescot, G., Barthelemy, O., Zeymer, U., Desch, S., de Waha-Thiele, S., Maier, L. S., Sandri, M., Akin, I., Fuernau, G., Ouarrak, T., Hauguel-Moreau, M., Schneider, S., Thiele, H., & Huber, K. (2020). Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA cardiology, 5(12), 1329-1337. https://doi.org/10.1001/jamacardio.2020.3377
Farhan, Serdar, et al. "Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial." JAMA cardiology vol. 5,12 (2020): 1329-1337. doi: https://doi.org/10.1001/jamacardio.2020.3377
Farhan S, Vogel B, Montalescot G, Barthelemy O, Zeymer U, Desch S, de Waha-Thiele S, Maier LS, Sandri M, Akin I, Fuernau G, Ouarrak T, Hauguel-Moreau M, Schneider S, Thiele H, Huber K. Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Cardiol. 2020 Dec 01;5(12):1329-1337. doi: 10.1001/jamacardio.2020.3377. PMID: 32845312; PMCID: PMC7450400.
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JAMA Cardiol. 2020 Dec 01;5(12):1329-1337. doi: 10.1001/jamacardio.2020.3377.

Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial.

JAMA cardiology

Serdar Farhan, Birgit Vogel, Gilles Montalescot, Olivier Barthelemy, Uwe Zeymer, Steffen Desch, Suzanne de Waha-Thiele, Lars S Maier, Marcus Sandri, Ibrahim Akin, Georg Fuernau, Taoufik Ouarrak, Marie Hauguel-Moreau, Steffen Schneider, Holger Thiele, Kurt Huber

Affiliations

  1. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
  2. Wilhelminenspital, Department of Cardiology, Vienna, Austria.
  3. ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France.
  4. Institut für Herzinfarktforschung, Ludwigshafen, Germany.
  5. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
  6. Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany.
  7. Department of Cardiology, Pneumology, and Intensive Care, University Hospital Regensburg, Regensburg, Germany.
  8. University Medical Centre Mannheim, First Department of Medicine, Faculty of Medicine, University of Heidelberg, Mannheim, Germany.
  9. Medical School, Sigmund Freud University, Vienna, Austria.

PMID: 32845312 PMCID: PMC7450400 DOI: 10.1001/jamacardio.2020.3377

Abstract

IMPORTANCE: Myocardial infarction with a culprit lesion located in the left main or proximal left anterior descending artery compared with other coronary segments is associated with more myocardium at risk and worse clinical outcomes.

OBJECTIVE: To evaluate the association of culprit lesion location with outcomes of culprit-lesion-only percutaneous coronary intervention with optional staged revascularization vs immediate multivessel percutaneous coronary intervention in patients with multivessel disease, myocardial infarction, and cardiogenic shock.

DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of the Culprit Lesion Only Coronary Intervention vs Multivessel Coronary Intervention in Cardiogenic Shock (CULPRIT-SHOCK), an investigator-initiated randomized, open-label clinical trial. Patients with multivessel disease, acute myocardial infarction, and cardiogenic shock were enrolled at 83 European centers from April 2013 through April 2017.

INTERVENTIONS: Patients were randomized to culprit-lesion-only percutaneous coronary intervention with optional staged revascularization or immediate multivessel percutaneous coronary intervention (1:1). For this analysis, patients were stratified by culprit lesion location in the left main or proximal left anterior descending artery group and other-culprit-lesion location group.

MAIN OUTCOMES AND MEASURES: End points included a composite of death or kidney replacement therapy at 30 days and death at 1 year.

RESULTS: The median age of the study population was 70 (interquartile range, 60-78 years) and 524 of the study participants were men (76.4%). Of the 685 patients, 33.4% constituted the left main or proximal left anterior descending artery group and 66.6% the other-culprit-lesion location group. The left main or proximal left anterior descending artery group had worse outcomes compared with the other-culprit-lesion location group (56.8% vs 47.5%; P = .02 for the composite end point at 30 days and 59.8% vs 50.1%; P = .02 for death at 1 year). In both groups, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a reduced risk of the composite end point at 30 days (49.1% vs 64.3% and 44.1% vs 50.9%; P for interaction = .27). At 1 year, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a significantly reduced risk of death in the left main or proximal left anterior descending artery but not the other-culprit-lesion location group (50.0% vs 69.6%; P = .003 and 49.8% vs 50.4%; P = .89; P for interaction = 0.02).

CONCLUSIONS AND RELEVANCE: In patients with multivessel disease with myocardial infarction and cardiogenic shock, a culprit lesion located in the left main or proximal left anterior descending artery vs other coronary segments was associated with worse outcomes. These patients may especially benefit from culprit-lesion-only percutaneous coronary intervention with optional staged revascularization, although further investigation is needed to confirm this finding.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01927549.

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