Background: The CULPRIT-SHOCK trial is a prime example of less is more. It randomized more than 700 patients to two revascularization strategies. Group-1 underwent culprit vessel only PCI and group 2 underwent complete multivessel revascularization. The results were in favor of culprit-lesion only PCI. The outcomes were favorable on immediate follow-up as well as 1-year follow-up. The trial was conducted to answer the important question of revascularization approach in STEMI patients as the prior trial showed that multivessel PCI leads to better outcomes (CvLPRIT trial 2015).
Title: One-Year Outcomes After PCI Strategies in Cardiogenic Shock
Design: Multicenter, randomized, open-label trial
Objective: To assess clinical outcomes after culprit-lesion-only PCI than with immediate multivessel PCI.
Year of publication: 2018
Inclusion Criteria: Patients who had AMI and cardiogenic shock were randomized to
Comparison groups: Culprit-lesion-only PCI (n=344) vs Immediate multivessel PCI (n=342)
Conclusion: Among patients with AMI and cardiogenic shock, the risk of death or renal-replacement therapy at 30 days was lower with culprit-lesion-only PCI than with immediate multivessel PCI, and mortality did not differ significantly between the two groups at 1-year follow-up.
Source: Thiele H, Akin I, Sandri S, et al. One-Year Outcomes after PCI Strategies in Cardiogenic Shock. N Engl J Med 2018;Aug 25:[Epub Ahead of Print].