CULPRIT-SHOCK Trial: PCI Strategies in Cardiogenic Shock

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.

N= 706

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)

Primary Outcome:

  • Primary End Point All-cause mortality + renal failure requiring renal-replacement therapy at 30 days  
    45.9% vs 55.4% (P=0.01)
     
  • Mortality at 1 year
    50.0% vs 56.9%, (RR, 0.88; 95% CI, 0.76-1.01)
     
  • Rehospitalization for heart failure at 1 year 
    5.2% vs 1.2%, (RR, 4.46; 95% CI, 1.53-13.04) 
     

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].