Clinical outcomes according to ECG presentations in infarct-related cardiogenic shock in the culprit lesion only PCI vs multivessel PCI in cardiogenic shock trial
Background - The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. - Research Question - In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation...
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
April 2021
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| In: |
Chest
Year: 2021, Jahrgang: 159, Heft: 4, Pages: 1415-1425 |
| ISSN: | 1931-3543 |
| DOI: | 10.1016/j.chest.2020.10.089 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.chest.2020.10.089 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0012369220353009 
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| Verfasserangaben: | Michel Zeitouni, Ibrahim Akin, Steffen Desch, Olivier Barthélémy, Delphine Brugier, Jean-Philippe Collet, Suzanne de Waha-Thiele, John P. Greenwood, Paul Guedeney, Georges Hage, Marie Hauguel-Moreau, Kurt Huber, Mathieu Kerneis, Marko Noc, Keith G. Oldroyd, Jan J. Piek, Stéphanie Rouanet, Stefano Savonitto, Pranas Serpytis, Johanne Silvain, Janina Stepinska, Eric Vicaut, Christiaan J. M. Vrints, Stephan Windecker, Uwe Zeymer, Holger Thiele, Gilles Montalescot |
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| 245 | 1 | 0 | |a Clinical outcomes according to ECG presentations in infarct-related cardiogenic shock in the culprit lesion only PCI vs multivessel PCI in cardiogenic shock trial |c Michel Zeitouni, Ibrahim Akin, Steffen Desch, Olivier Barthélémy, Delphine Brugier, Jean-Philippe Collet, Suzanne de Waha-Thiele, John P. Greenwood, Paul Guedeney, Georges Hage, Marie Hauguel-Moreau, Kurt Huber, Mathieu Kerneis, Marko Noc, Keith G. Oldroyd, Jan J. Piek, Stéphanie Rouanet, Stefano Savonitto, Pranas Serpytis, Johanne Silvain, Janina Stepinska, Eric Vicaut, Christiaan J. M. Vrints, Stephan Windecker, Uwe Zeymer, Holger Thiele, Gilles Montalescot |
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| 520 | |a Background - The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. - Research Question - In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? - Study Design and Methods - Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. - Results - Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P = .015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P = .85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P = .36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P = .42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P = .12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P = .91 and P = .97 for interaction). - Interpretation - In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum. | ||
| 650 | 4 | |a cardiogenic shock | |
| 650 | 4 | |a left bundle branch block | |
| 650 | 4 | |a NSTEMI | |
| 650 | 4 | |a percutaneous coronary intervention | |
| 650 | 4 | |a STEMI | |
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