Comparative outcomes of culprit-only versus complete revascularisation in cardiogenic shock complicating acute myocardial infarction: insights from the Gulf-Cardiogenic Shock registry.
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Daoulah Amin, Seraj Shaber, Elmahrouk Ahmed, Arafat Amr A, Panduranga Prashanth, Almahmeed Wael, Arabi Abdulrahman, Alobaikan Sultan, Al Shehri Mohammed, Yousif Nooraldaem, Aloui Hatem, Qutub Mohammed, Alharbi Waleed, Rajan Rajesh, Kahin Mokhtar, Al Maashani Said, Hassan Taher, Al Suwaidi Jassim, AlQahtani Awad Abdulrazaq, Aldossari Mubarak Abdulhadi, Al-Jarallah Mohammed, Alshehri Ali, Elganady Abdelmaksoud, Alzahrani Badr, Aldossari Alaa, Alqahtani Abdulrahman M, Al Nasser Faisal, Amin Haitham, Alama Mohamed N, Almarghany Alsayed Ali, Alenezi Abdullah, Almerri Khaled, Kanbr Omar, Jamjoom Ahmed, Elmahrouk Youssef, Abdulhabeeb Ibrahim A M, Balghith Mohammed Ali, Hersi Ahmad, Al Rawahi Abeer Said Mohamed, Albasiouny Alkholy Marwa Abd Elghany, Hussien Adnan, Almoghairi Abdulrahman, Alama Mohamed Mohammednabil A, Ghani Mohamed Ajaz, Al Hussini Ayman, Basardah Ayman, Alshehri Bandar, Al Obaid Laura, Alshali Khalid, Saati Sara Shawki, Abualnaja Seraj, Chachar Tarique Shahzad, Khan Hassan, Hashmani Shahrukh, Ghonim Ahmed A, Alsofayan Razan Waleed W, Shawky Abeer M, Lotfi Amir
Аннотация
DESIGN: Retrospective subgroup analysis of the multicentre Gulf-Cardiogenic Shock registry.
SETTING: 13 tertiary care centres across six Gulf countries (Saudi Arabia, Qatar, Oman, UAE, Kuwait and Bahrain) between January 2020 and December 2022.
PARTICIPANTS: 961 patients with angiographically confirmed multivessel coronary artery disease who underwent PCI were included from the Gulf-Cardiogenic Shock registry. Patients were divided into culprit-only PCI group (n=792, 82.4%) and multivessel PCI group (n=169, 17.6%). Patients with single-vessel disease were excluded.
INTERVENTIONS: Patients underwent either culprit-only PCI (intervention limited to the culprit artery) or multivessel PCI (immediate intervention to both culprit and non-culprit arteries during the same procedure).
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was in-hospital all-cause mortality. Secondary outcomes included reinfarction, cerebrovascular accident, major and minor bleeding events, target lesion revascularisation, target vessel revascularisation, hospital stay duration and freedom from major adverse cardiac and cerebrovascular events (MACCEs) at 6 and 12 months.
RESULTS: Hospital mortality was comparable between multivessel PCI and culprit-only PCI groups (43.2% vs 46.1%; p=0.493). Freedom from MACCE rates at 6 and 12 months were 62% and 46% for multivessel PCI versus 70% and 49% for culprit-only PCI, respectively (log-rank p=0.711). Subgroup analysis revealed that culprit-only PCI was associated with increased hospital mortality in patients older than 70 years (OR 1.55, 95% CI: 1.01 to 2.39). Multivariable analysis of the interaction between revascularisation strategy and the subgroups revealed that culprit vessel revascularisation was associated with increased mortality in patients with left main disease (OR: 1.99 (95% CI: 1.22 to 3.27), p=0.006) and left anterior descending lesions (OR: 1.54 (95% CI: 1.06 to 2.25), p=0.025).
CONCLUSIONS: No statistically significant differences in hospital mortality or long-term MACCE-free survival were observed between culprit-only PCI and multivessel PCI strategies in patients with cardiogenic shock complicating acute myocardial infarction. However, patients older than 70 years may benefit from a multivessel PCI approach. These findings support current guideline recommendations favouring culprit-only PCI due to reduced procedural complexity while highlighting the need for individualised treatment strategies based on patient age and clinical factors. Further prospective randomised studies are needed to validate these age-specific findings and identify optimal patient selection criteria for each revascularisation strategy.