6/28/23, 12:23 AM CULPRIT-SHOCK Pathway Feedback Search Clinical Topics Home Studies CULPRIT SHOCK CULPRIT SHOCK Disease Disease Disease Cardiogenic shock Coronary artery disease Non-ST Trial question What is the role of PCI strategy of early revascularization of the culprit lesion only compared with immediate multivessel revascularization in patients with acute myocardial infarction and cardiogenic shock? Study design Multi-center Open label RCT Population Characteristics of study participants 23.7% female N = 706 76.3% male 706 patients (161 female, 524 male) Inclusion criteria: patients who had acute ST-segment elevation or non-ST-segment elevation myocardial infarction that was complicated by cardiogenic shock Key exclusion criteria: resuscitation for > 30 minutes, no intrinsic heart action, severe deficit in cerebral function with fixed dilated pupils, indication for primary urgent CABG, single-vessel coronary artery disease, mechanical cause of cardiogenic shock, shock with a noncardiogenic cause, massive PE Interventions N=344 culprit lesion-only percutaneous coronary revascularization (the use of standard interventional techniques, with the option of staged revascularization of nonculprit lesions) N=342 immediate multivessel culprit lesion-only percutaneous coronary revascularization (recanalizing chronic total occlusions during acute phase; recommended maximum dose of https://web.pathway.md/studies/recWNWTccNpcCyVp0 1/2 6/28/23, 12:23 AM CULPRIT-SHOCK Pathway contrast material was 300 ml) Primary outcome Death or renal-replacement therapy at 30 days 55.4 % 55.4 45.9 41.5 % 27.7 % Significant decrease 13.8 % NNT = 11 0.0 % Immediate multivessel culprit lesion-only percutaneous coronary revascularization Culprit lesion-only percutaneous coronary revascularization Significant decrease in death or renal-replacement therapy at 30 days (45.9% vs. 55.4%; RR 0.83, 95% CI 0.71 to 0.96) Secondary outcomes Significant decrease in death (43.3% vs. 51.6%; RR 0.84, 95% CI 0.72 to 0.98) Safety outcomes No significant difference in rates of bleeding and stroke. Conclusion In patients who had acute ST-segment elevation or non-ST-segment elevation myocardial infarction that was complicated by cardiogenic shock, culprit lesion-only percutaneous coronary revascularization was superior to immediate multivessel culprit lesion-only percutaneous coronary revascularization with respect to death or renal-replacement therapy at 30 days. Reference Thiele H, Akin I, Sandri M et al. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. N Engl J Med. 2017 Dec 21;377(25):2419-2432. Open reference URL https://web.pathway.md/studies/recWNWTccNpcCyVp0 2/2