Will CULPRIT-SHOCK change my practice? The CULPRIT-SHOCK trial: culprit lesion-only PCI vs. multivessel PCI in patients with acute myocardial infarction and cardiogenic shock
This summary report aims to capture the content of the session at EuroPCR 2018 that reviewed the implications for clinical practice of the CULPRIT-SHOCK trial, in order to share a critical analysis of the trial and report the views expressed in the interactive discussion. This article does not constitute an independent review of the topic by the authors. The CULPRIT-SHOCK study 1 tested the hypothesis that percutaneous coronary intervention (PCI) of culprit lesion only, with the option of
... the option of staged revascularisation of non-culprit lesions, would result in better clinical outcomes than immediate multivessel PCI in patients with multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock. Trial headlines indicated that this study is a landmark study and a "game changer" for clinical practice, similarly to the IABP-SHOCK 2 study that has resulted in a large reduction in the use of intra-aortic balloon pump (IABP) in patients with cardiogenic shock. IABP is nevertheless still used in 25-40% of cardiogenic shock cases. Will the results of CULPRIT-SHOCK follow the same path or will they change our practice? The case presentation A 67-year-old man was admitted to a tertiary hospital with non-ST-segment elevation myocardial infarction (NSTEMI) complicated by cardiogenic shock during the first day of admission, prior to revascularisation. The coronary angiogram showed a distal left main with some haziness due to a large amount of thrombus involving mainly the proximal left anterior descending artery (LAD), which was patent with Thrombolysis In Myocardial Infarction (TIMI) flow 2, and a totally occluded left circumflex atery (LCx), with no distal collateral filling.