EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021
Culprit lesion location and outcomes in patients with multivessel disease and infarct-related cardiogenic shock: a core laboratory analysis of the CULPRIT-SHOCK trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Hauguel-Moreau Marie, Barthélémy Olvier, Farhan Serdar, Huber Kurt, Rouanet Stéphanie, Zeitouni Michel, Guedeney Paul, Hage Georges, Vicaut Eric, Zeymer Uwe, Desch Steffen, Thiele Holger, Montalescot Gilles
Аннотация
BACKGROUND: Critical culprit lesion locations (CCLL) such as left main (LM) and proximal left anterior descending (LAD) are associated with worse clinical outcome in myocardial infarction without cardiogenic shock (CS).
AIMS: We aimed to assess whether CCLL identify a subgroup of patients with poorer prognosis when presenting with CS.
METHODS: In the CULPRIT-SHOCK trial, a core laboratory reviewed all coronary angiograms to identify CCLL. A CCLL was defined as a culprit lesion with a >70% diameter stenosis of the LM, LM equivalent (>70% diameter stenosis of both proximal LAD and proximal circumflex), proximal LAD or last remaining vessel. We evaluated the primary study endpoint of the CULPRIT-SHOCK trial according to CCLL.
RESULTS: A total of 269 (43%) out of 626 patients eligible for this analysis had a CCLL. Death or renal replacement therapy within 30 days, death within 30 days and death within one year were significantly higher in the CCLL than in the non-CCLL group (58.4% vs 43.4%, p<0.001, 55.8% vs 39.5%, p<0.001, 61.0% vs 44.5%, p<0.001, respectively). This was consistent after adjustment for baseline and angiographic characteristics. No interaction with the randomisation group (culprit lesion-only or immediate multivessel PCI) was found.
CONCLUSIONS: CCLL is frequent in CS and independently associated with worse clinical outcomes irrespective of the revascularisation strategy.
TRIAL REGISTRATION: www.clinicaltrials.gov NCT01927549.
AIMS: We aimed to assess whether CCLL identify a subgroup of patients with poorer prognosis when presenting with CS.
METHODS: In the CULPRIT-SHOCK trial, a core laboratory reviewed all coronary angiograms to identify CCLL. A CCLL was defined as a culprit lesion with a >70% diameter stenosis of the LM, LM equivalent (>70% diameter stenosis of both proximal LAD and proximal circumflex), proximal LAD or last remaining vessel. We evaluated the primary study endpoint of the CULPRIT-SHOCK trial according to CCLL.
RESULTS: A total of 269 (43%) out of 626 patients eligible for this analysis had a CCLL. Death or renal replacement therapy within 30 days, death within 30 days and death within one year were significantly higher in the CCLL than in the non-CCLL group (58.4% vs 43.4%, p<0.001, 55.8% vs 39.5%, p<0.001, 61.0% vs 44.5%, p<0.001, respectively). This was consistent after adjustment for baseline and angiographic characteristics. No interaction with the randomisation group (culprit lesion-only or immediate multivessel PCI) was found.
CONCLUSIONS: CCLL is frequent in CS and independently associated with worse clinical outcomes irrespective of the revascularisation strategy.
TRIAL REGISTRATION: www.clinicaltrials.gov NCT01927549.