The ability to achieve complete revascularization is associated with improved in‐hospital survival in cardiogenic shock due to myocardial infarction: Manitoba cardiogenic shock registry investigators

Abstract

The ability to achieve complete revascularization may be strongly associated with improved in-hospital survival in patients with cardiogenic shock.

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

“…176 Some observational studies have reported potential benefits with multivessel PCI in CS, whereas clinical practice guidelines recommend nonculprit PCI for "critical (≥90% diameter) stenoses or highly unstable lesions." 145,[177][178][179][180][181] The CULPRIT-SHOCK trial (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock), designed to be the largest CS trial ever, is currently enrolling patients to test this question in a prospective, randomized fashion. Historically, diagnostic angiography and PCI have been performed with a femoral arterial access site, although radial access has been more recently advocated as a safer alternative for arterial access.…”

The Role of Multivessel Coronary Intervention in ST-Segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock

“…However, the study was limited by unmeasured cofounders, such as the lack of reliable identification of IRA, information about the degree of stenosis of the non-IRA, and outcomes being limited to those in hospital. Hussain et al (9) along with the Manitoba Cardiogenic Shock Registry Investigators reported that among the 210 patients identified with CS, multivessel revascularization (n = 22) was associated with an 88% survival, acknowledging that this was from a small subgroup analysis. Analyzed data from the Euro Heart Survey PCI Registry by Bauer et al (10) did not find multivessel PCI to have impact on in-hospital mortality.…”

“…Optimal revascularization strategies in these patients remain controversial (7)(8)(9)(10)(11)(12)(13). Guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology state that only the infarctrelated artery (IRA) should be treated during the initial intervention for patients not in CS (14,15).…”

“…One successful approach directed at trainees was to hmit clinical ordering privileges to basic tests only and then to require that all advanced testing be approved by a supervising attending (7). Although education alone is ineffective, multifaceted programs using simple testing guidelines combined with frequent audit and feedback can also reduce unnecessary testing (3,8,9). Other factors such as social interaction and social learning may also be important components that promote changes in behavior (10).…”

The great taboo of non–infarct-related artery revascularization during primary percutaneous coronary intervention

“…16 However, in the observational Manitoba cardiogenic shock registry, complete revascularization was strongly associated with improved in-hospital survival in patients with cardiogenic shock. 17 The above studies have significant limitations including differences in baseline characteristics between the groups, and no information as to why patients underwent multivessel revascularization or the baseline medical management. In these studies statistical modeling cannot adequately account for unmeasured confounders.…”