Thiele, H. and Akin, I. and Sandri, M. and de Waha-Thiele, S. and Meyer-Saraei, R. and Fuernau, G. and Eitel, I. and Nordbeck, P. and Geisler, T. and Landmesser, U. and Skurk, C. and Fach, A. and Jobs, A. and Lapp, H. and Piek, J. J. and Noc, M. and Goslar, T. and Felix, S. B. and Maier, L. S. and Stepinska, J. and Oldroyd, K. and Serpytis, P. and Montalescot, G. and Barthelemy, O. and Huber, K. and Windecker, S. and Hunziker, L. and Savonitto, S. and Torremante, P. and Vrints, C. and Schneider, S. and Zeymer, U. and Desch, S. (2018) One-Year Outcomes after PCI Strategies in Cardiogenic Shock. NEW ENGLAND JOURNAL OF MEDICINE, 379 (18). pp. 1699-1710. ISSN 0028-4793, 1533-4406
Full text not available from this repository. (Request a copy)Abstract
BACKGROUND Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year. METHODS We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI. The results for the primary end point of death or renal-replacement therapy at 30 days have been reported previously. Prespecified secondary end points at 1 year included death from any cause, recurrent myocardial infarction, repeat revascularization, rehospitalization for congestive heart failure, the composite of death or recurrent infarction, and the composite of death, recurrent infarction, or rehospitalization for heart failure. RESULTS As reported previously, at 30 days, the primary end point had occurred in 45.9% of the patients in the culprit-lesion-only PCI group and in 55.4% in the multivessel PCI group (P = 0.01). At 1 year, death had occurred in 172 of 344 patients (50.0%) in the culpritlesion-only PCI group and in 194 of 341 patients (56.9%) in the multivessel PCI group (relative risk, 0.88; 95% confidence interval [CI], 0.76 to 1.01). The rate of recurrent infarction was 1.7% with culprit-lesion-only PCI and 2.1% with multivessel PCI (relative risk, 0.85; 95% CI, 0.29 to 2.50), and the rate of a composite of death or recurrent infarction was 50.9% and 58.4%, respectively (relative risk, 0.87; 95% CI, 0.76 to 1.00). Repeat revascularization occurred more frequently with culprit-lesion-only PCI than with multivessel PCI (in 32.3% of the patients vs. 9.4%; relative risk, 3.44; 95% CI, 2.39 to 4.95), as did rehospitalization for heart failure (5.2% vs. 1.2%; relative risk, 4.46; 95% CI, 1.53 to 13.04). CONCLUSIONS Among patients with acute myocardial infarction and cardiogenic shock, the risk of death or renal-replacement therapy at 30 days was lower with culprit-lesion-only PCI than with immediate multivessel PCI, and mortality did not differ significantly between the two groups at 1 year of follow-up. (Funded by the European Union Seventh Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549.)
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE MYOCARDIAL-INFARCTION; PERCUTANEOUS CORONARY INTERVENTION; ST-SEGMENT ELEVATION; ONE-YEAR SURVIVAL; CULPRIT LESION; EARLY REVASCULARIZATION; ANGIOGRAPHIC FINDINGS; MULTIVESSEL DISEASE; RANDOMIZED-TRIAL; OPEN-LABEL; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 10 Oct 2019 09:08 |
| Last Modified: | 10 Oct 2019 09:08 |
| URI: | https://pred.uni-regensburg.de/id/eprint/13602 |
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