Key result
Early invasive treatment with culprit-only revascularization is preferred in cardiogenic shock, whereas multivessel revascularization is supported in uncomplicated STEMI.
This review summarizes current evidence supporting culprit-only revascularization in AMI with cardiogenic shock and multivessel revascularization in uncomplicated STEMI, while noting the lack of evidence for routine IABP use.
Supports culprit-only PCI in AMI shock; leaves open optimal mechanical circulatory support strategies.
Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction and continues to have high mortality. Early invasive treatment is the default therapeutic approach in these patients. On the basis of the results of the CULPRIT-SHOCK trial, culprit-only revascularization during the acute phase is preferred over multivessel revascularization. Routine use of intra-aortic balloon pump (IABP) is not recommended; however, the use of mechanical circulatory support has been increasing despite limited observational data to support its use. Several studies support multivessel revascularization in patients with uncomplicated ST-segment elevation acute myocardial infarction and simple nonculprit lesions to improve subsequent clinical outcomes.
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Xenogiannis et al. (2019) conducted a review in Acute coronary syndromes. Coronary revascularization and hemodynamic support was evaluated. Early invasive treatment with culprit-only revascularization is preferred in cardiogenic shock, whereas multivessel revascularization is supported in uncomplicated STEMI.
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