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Outcomes and Procedural Burden of Culprit-Only vs. Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Retrospective Analysis of Real-World Data
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 04 - INOVAÇÃO EM CUIDADOS INTENSIVOS: NOVAS INTERVENÇÕES EM CHOQUE CARDIOGÉNICO E SÍNDROMAS CORONÁRIAS AGUDAS
Speaker:
Ana Raquel Carvalho Santos
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Raquel Carvalho Santos; Francisco Albuquerque; André Grazina; Pedro Brás; Tiago Mendonça; Luis Morais; Ruben Ramos; António Fiarresga; Lidia Sousa; Inês Rodrigues; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The optimal revascularization strategy for ST-segment elevation myocardial infarction complicated by cardiogenic shock remains controversial. While randomized trials, such as CULPRIT-SHOCK, demonstrated benefits of percutaneous coronary intervention (PCI) limited to the culprit vessel, real-world data remain limited.</span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">This retrospective study analyzed 84 patients with cardiogenic shock undergoing primary PCI. Of these, 53 patients with multivessel coronary artery disease were divided into culprit-only PCI (n=38) and multivessel PCI (n=15) groups. The mean age was significantly higher in the culprit-only group (72.3 ± 11.3 years) than in the multivessel group (58.5 ± 13.8 years, p=0.0006). Primary outcomes included mortality and procedural complications; secondary endpoints included stent use, angiographic complications, bifurcation lesions, and clinical variables such as cardiopulmonary resuscitation (CPR) and mechanical circulatory support. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Short-term mortality was similar between groups (p=0.4218), with procedural death occurring in 15.8% of culprit-only PCI patients and 26.7% of multivessel PCI patients. Procedural burden was higher in multivessel PCI, requiring 3 or more stents in 40% of patients compared to 18% in culprit-only PCI. Angiographic complications occurred significantly more frequently in the multivessel PCI group (86.7% vs. 39.5%, p=0.0009), including coronary dissection and no-reflow phenomenon.</span></span><br /> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Culprit-only PCI predominantly targeted the proximal left anterior descending artery (39.5%), proximal right coronary artery (28.9%), and left main coronary artery (7.9%). Multivessel PCI addressed bifurcation lesions in 26.7% of culprit-treated vessels and 6.7% of second-treated vessels. Clinical outcomes, including CPR (36.8% in culprit-only vs. 20% in multivessel PCI) and ventricular arrhythmias, showed no significant differences. Intra-aortic balloon pump use was more common in multivessel PCI (66.7% vs. 34.2%), while Impella and extracorporeal membrane oxygenation (ECMO) use remained low overall.</span></span></p> <p><br /> <span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif">In conclusion, among 53 patients with multivessel disease and cardiogenic shock, culprit-only PCI was associated with fewer complications (39.5% vs. 86.7%, p=0.0009) and reduced procedural burden compared to multivessel PCI. Despite addressing bifurcation and complex lesions, multivessel PCI did not improve short-term mortality. These findings align with prior randomized data and highlight the procedural safety of culprit-only PCI in this critically ill population.</span></span></p>
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