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
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