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  • Do the Bare Minimum During Percutaneous Revascularization of Myocardial Infarction in Cardiogenic Shock

    Multivessel coronary artery disease (MVCAD) is seen in 40% to 50% of ST elevation myocardial infarction (STEMI) patients. In hemodynamically stable patients with STEMI and MVCAD, complete revascularization using multivessel percutaneous coronary intervention (PCI) is associated with better clinical outcomes than culprit-vessel-only PCI is. The latest randomized study, presented at the European Society of Cardiology Congress, on September 1, 2019, the Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trial, demonstrated superiority in decreasing the risk of cardiovascular death or myocardial infarction with complete revascularization in comparison to culprit-vessel-only revascularization. Cardiogenic shock occurs in 5% to 10% of patients with acute myocardial infarction (AMI); however, it is associated with up to 50% early mortality. American College of Cardiology and American Heart Association guidelines give no specific recommendation on PCI strategy in AMI with MVCAD complicated by cardiogenic shock because of a dearth of randomized clinical trial data before the CULPRIT SHOCK (CULPRIT Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial.

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