Impact of chronic total occlusion and revascularization strategy in patients with infarct-related cardiogenic shock: A subanalysis of the culprit-shock trial
Autor: | Michel Zeitouni, Steffen Desch, Ibrahim Akin, Suzanne de Waha-Thiele, Steffen Schneider, Marcus Sandri, Holger Thiele, Pavel Overtchouk, Uwe Zeymer, Taoufik Ouarrak, Paul Guedeney, Georg Fuernau, Micheal Behnes, Nassim Braik, Olivier Barthelemy, Gilles Montalescot, Stéphanie Rouanet, Marie Hauguel-Moreau |
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Přispěvatelé: | Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), University of Heidelberg, Medical Faculty, Universität Leipzig [Leipzig], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], University Hospital Leipzig, Universität zu Lübeck [Lübeck], StatEthic, Klinikum Ludwigshafen [Germany], CCSD, Accord Elsevier, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Universität zu Lübeck = University of Lübeck [Lübeck] |
Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Shock Cardiogenic 030204 cardiovascular system & hematology Revascularization Culprit 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Cause of Death Internal medicine Humans Medicine ST segment 030212 general & internal medicine Myocardial infarction cardiovascular diseases Mortality Aged Aged 80 and over business.industry Cardiogenic shock Coronary Stenosis Percutaneous coronary intervention Odds ratio Middle Aged Prognosis medicine.disease [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system 3. Good health Renal Replacement Therapy Logistic Models Treatment Outcome Coronary Occlusion Chronic Disease Multivariate Analysis Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business |
Zdroj: | American Heart Journal American Heart Journal, Elsevier, 2021, 232, pp.185-193. ⟨10.1016/j.ahj.2020.11.009⟩ American Heart Journal, 2021, 232, pp.185-193. ⟨10.1016/j.ahj.2020.11.009⟩ |
ISSN: | 0002-8703 |
DOI: | 10.1016/j.ahj.2020.11.009⟩ |
Popis: | International audience; BackgroundThe impact of coronary artery chronic total occlusion (CTO) and its management with percutaneous coronary intervention (PCI) in the setting of myocardial infarction (MI) related cardiogenic shock (CS) remains unclear.MethodsThis is a pre-specified analysis from the culprit-lesion-only PCI vs multivessel PCI in CS (CULPRIT-SHOCK) trial which randomized patients presenting with MI and multivessel disease complicated by CS to a culprit-lesion-only or immediate multivessel PCI strategy. CTO was defined by central core-laboratory evaluation. The independent associations between the presence of CTO and adverse outcomes at 30 days and 1 year were assessed using multivariate logistics models.ResultsA noninfarct related CTO was present in 157 of 667 (23.5%) analyzed patients. Patients presenting with CTO had more frequent diabetes mellitus or prior PCI but less frequently presented with ST segment elevation MI as index event. The presence of CTO was associated with higher rate of death at 30 days (adjusted Odds ratio 1.63; 95% confidence interval [CI] 1.01-2.60). Rate of death at 1 year was also increased but did not reach statistical significance (adjusted Odds ratio 1.62; 95%CI 0.99-2.66). Compare to immediate multivessel PCI, a strategy of culprit-lesion-only PCI was associated with lower rates of death or renal replacement therapy at 30 days in patients with and without CTO (Odds ratio 0.79 95%CI 0.42-1.49 and Odds ratio 0.67 95%CI 0.48-0.96, respectively), without significant interaction (P = .68).ConclusionsIn patients with MI-related CS and multivessel disease, the presence of CTO is associated with adverse outcomes while a strategy of culprit-lesion-only PCI seems beneficial regardless of the presence of CTO. |
Databáze: | OpenAIRE |
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