Author + information
- Received January 15, 2020
- Revision received February 13, 2020
- Accepted March 3, 2020
- Published online May 18, 2020.
- Alejandro Lemor, MDa,∗ (, )@alejandrolemor,
- Mir B. Basir, DOa,
- Kirit Patel, MDb,
- Brian Kolski, MDc,
- Amir Kaki, MDd,
- Navin Kapur, MDe,
- Robert Riley, MDf,
- John Finley, MDg,
- Andrew Goldsweig, MDh,
- Herbert D. Aronow, MDi,
- P. Matthew Belford, MDj,
- Behnam Tehrani, MDk,
- Alexander G. Truesdell, MDk,
- David Lasorda, MDl,
- Aditya Bharadwaj, MDm,
- Ivan Hanson, MDn,
- Thomas LaLonde, MDd,
- Sarah Gorgis, MDa,
- William O'Neill, MDa,
- on behalf of the National Cardiogenic Shock Initiative Investigators
- aDepartment of Cardiology, Henry Ford Hospital, Detroit, Michigan
- bDepartment of Cardiology, St. Joseph Mercy Oakland, Pontiac, Michigan
- cDepartment of Cardiology, St. Joseph's Hospital–Orange, Orange, California
- dDepartment of Cardiology, Ascension St. John Hospital–Detroit, Detroit, Michigan
- eDepartment of Cardiology, Tufts Medical Center, Boston, Massachusetts
- fThe Christ Hospital Health Network, Cincinnati, Ohio
- gDepartment of Cardiology, Mercy Fitzgerald Hospital, Yeadon, Pennsylvania
- hDepartment of Cardiology, University of Nebraska, Omaha, Nebraska
- iDepartment of Cardiology, Alpert Medical School at Brown University, Providence, Rhode Island
- jDepartment of Cardiology, Wake Forest Baptist Health, Winston-Salem, North Carolina
- kDepartment of Cardiology, Inova Fairfax Hospital, Falls Church, Virginia
- lDepartment of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
- mDepartment of Cardiology, Loma Linda Medical Center, Loma Linda, California
- nDepartment of Cardiology, Beaumont Hospital–Royal Oak, Royal Oak, Michigan
- ↵∗Address for correspondence:
Dr. Alejandro Lemor, Henry Ford Hospital, Cardiovascular Department, 2799 West Grand Boulevard, Detroit, Michigan 48202.
Objectives This study sought to compare outcomes of patients enrolled in the NCSI (National Cardiogenic Shock Initiative) trial who were treated using a revascularization strategy of percutaneous coronary intervention (PCI) of multivessel PCI (MV-PCI) versus culprit-vessel PCI (CV-PCI).
Background In patients with multivessel disease who present with acute myocardial infarction and cardiogenic shock (AMICS), intervening on the nonculprit vessel is controversial. There are conflicting published reports and lack of evidence, particularly in patients treated with early mechanical circulatory support (MCS).
Methods From July 2016 to December 2019, patients who presented with AMICS to 57 participating hospitals were included in this analysis. All patients were treated using a standard shock protocol emphasizing early MCS, revascularization, and invasive hemodynamic monitoring. Patients with multivessel coronary artery disease (MVCAD) were analyzed according to whether CV-PCI or MV-PCI was undertaken during the index procedure.
Results Of 198 patients with MVCAD, 126 underwent MV-PCI (64%) and 72 underwent CV-PCI (36%). Demographics between the cohorts were similar with respect to age, sex, history of diabetes, prior PCI or coronary artery bypass grafting, and prior history of myocardial infarction. Patients who underwent MV-PCI had a trend toward more severe impairment of cardiac output and worse lactate clearance on presentation, and cardiac performance was significantly worse at 12 h. However, 24 h from PCI, the hemometabolic derangements were similar. Survival and rates of acute kidney injury were not significantly different between groups (69.8% MV-PCI vs. 65.3% CV-PCI; p = 0.51; and 29.9% vs. 34.2%; p = 0.64, respectively).
Conclusions In patients with MVCAD presenting with AMICS treated with early MCS, revascularization of nonculprit lesions was associated with similar hospital survival and acute kidney injury when compared with culprit-only PCI. Selective nonculprit PCI can be safety performed in AMICS in patients supported with mechanical circulatory support.
Dr. Basir has received consultant fees from Abiomed, Abbott Vascular, Cardiovascular Systems, Chiesi, Procyrion, and Zoll. Dr. Kolski has served on a scientific advisory board for Abiomed. Dr Kaki has received speaker and proctor fees from Abiomed. Dr. Kapur has received institutional research grants/speaker fees/consulting honoraria from Abbott, Abiomed, Boston Scientific, Medtronic, LivaNova, MD Start, and Precardia. Dr. Riley has received consultant and speaker fees from Boston Scientific, Medtronic, and Asahi. Dr. Tehrani has received consultant/speaker fees from Abiomed and Medtronic. Dr. Truesdell has received consultant/speaker fees from Abiomed. Dr. Lasorda has received speaker fees from Abiomed. Dr. Bharadwaj has received speaker and proctor fees from Abiomed. Dr. Hanson has received speaker fees from Abiomed. Dr. O’Neill has received consultant fees from Abiomed, Boston Scientific, and Medtronic; speaker fees from Abiomed and Medtronic; and grant/research support from St. Jude Medical, Edwards Lifesciences, and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received January 15, 2020.
- Revision received February 13, 2020.
- Accepted March 3, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.