Culprit Lesion PCI Superior to Immediate Multivessel PCI in CAD

HealthDay News — Percutaneous coronary intervention (PCI) of the culprit lesion is associated with better 30-day outcomes than immediate multivessel PCI among patients with multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, according to a study published in the New England Journal of Medicine to coincide with the Cardiovascular Research Foundation Transcatheter Cardiovascular Therapeutics meeting, being held October 29 to November 2 in Denver.

Holder Thiele, MD, from University Hospital in Leipzig, Germany, and colleagues randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to either PCI of the culprit lesion only (with the option of staged revascularization of nonculprit lesions) or immediate multivessel PCI.

The researchers found that at 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 45.9% of patients in the culprit-lesion-only PCI group vs 55.4% in the multivessel PCI group (relative risk, 0.83; 95% confidence interval, 0.71 to 0.96; P =.01). For death, the relative risk in the culprit-lesion-only group was 0.84 (95% confidence interval, 0.72 to 0.98; P =.03) vs the multivessel PCI group. Similarly, the risk of renal-replacement therapy was 0.71 (95% confidence interval, 0.49 to 1.03; P =.07). There were no significant differences between the groups with respect to time to hemodynamic stabilization, risk of catecholamine therapy, levels of troponin T and creatine kinase, or rates of bleeding and stroke.

“Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those who underwent immediate multivessel PCI,” conclude the authors.

Several authors disclosed ties to pharmaceutical and medical device companies.

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Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock [published online October 30, 2017]. N Engl J Med. doi: 10.1056/NEJMoa1710261