• Cardiogenic Shock in the Setting of Acute Myocardial Infarction: The Swinging Pendulum of Revascularization

    Patients presenting with acute myocardial infarction (AMI) and cardiogenic shock represent a particularly high-risk subset of patients. Percutaneous coronary intervention (PCI) remains the single most important therapeutic intervention resulting in improved survival in this population. It is also important to acknowledge that many patients presenting with AMI complicated by cardiogenic shock frequently have severe multivessel coronary artery disease, raising the clinical challenge of whether to proceed with PCI of other significant stenoses following successful PCI of the culprit lesion. While this question has been addressed through multiple randomized controlled trials in the setting of ST-elevation myocardial infarction (STEMI), it is important to note that these trials often included subtle differences in methodology that make major differences in clinical practice. One important question is whether PCI for multivessel disease should be performed in the index procedure versus deferring PCI of the non-culprit lesions. If deferred, a separate question is whether to perform PCI during the index hospitalization. In regard to multivessel PCI in the setting of STEMI, a recent meta-analysis of the six randomized controlled trials to date on complete multivessel PCI vs. culprit-only PCI for STEMI confirmed the benefit of multivessel PCI (including a staged strategy) for reducing cardiovascular death and recurrent MI . The COMPLETE trial supported the concept of multivessel PCI with a staged PCI strategy for the non-culprit lesions but did not find a significant difference between staged PCI in the index hospitalization vs. planned staged PCI at a later time after the index hospitalization when compared with a culprit-only strategy......

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    Click to view full article: https://doi.org/10.1016/j.carrev.2020.02.028

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