Clinical Research & Data, Complete Revascularization, AMI Cardiogenic Shock
Multivessel Versus Culprit Vessel PCI in Cardiogenic Shock
Alejandro Lemor, MD, MS, discusses multivessel PCI versus culprit vessel PCI in patients with cardiogenic shock from the National Cardiogenic Shock Initiative (NCSI) Study. He presented this data at TCT 2019 in San Francisco. Dr. Lemor is a cardiology fellow at Henry Ford Hospital in Detroit.
Is it safe to do multivessel PCI when you are supporting a patient with cardiogenic shock with Impella? Dr. Lemor discusses survival rates in patients in the NCSI registry, with AMI cardiogenic shock and Impella® support, undergoing multivessel or culprit vessel PCI.
Over the past few years, guideline recommendations regarding multivessel PCI have changed. For example, in 2013, the AHA/ACC recommendation was “PCI should not be performed in a non-infarct artery at the time of primary PCI in patients with STEMI who are hemodynamically stable.” By 2015, however, the guidelines had changed to state, “PCI of a noninfarct artery may be considered in selected patients with STEMI and multivessel disease who are hemodynamically stable, either at the time of primary PCI or as a planned staged procedure.”
In the patient population Dr. Lemor studied, about 65% of the patients had multivessel CAD. The treating interventional cardiologists decided whether to perform multivessel PCI or culprit vessel PCI. A majority (64%) of the patients with multivessel CAD underwent multivessel PCI while 36% underwent culprit vessel PCI.
In his discussion of results, Dr. Lemor explains that the sample size was small and did not show statistically significant differences. However, in patients with pre-Impella lactate ≤4, survival was 84% in the multivessel PCI group compared to 70% in the culprit vessel group. In addition, he notes, “There was a trend of benefit in actually doing multivessel PCI in special subgroups, like diabetic patients, patients with systolic heart failure, patients with prior CABG, or patients that presented with NSTEMI.”
In terms of overall survival, Dr. Lemor notes survival rates of 71% in patients who underwent multivessel PCI and 74% in those who underwent culprit vessel PCI. “There was no statistical significance between both groups,” he states, “as well, no difference between the rates of AKI.”
Thus, in answer to the question of whether it is safe to do multivessel PCI when you are supporting a patient with cardiogenic shock with Impella, Dr. Lemor concludes, “Our results show that there is no difference in the mortality or rates of AKI when you do multivessel versus culprit vessel in someone that presents with AMI cardiogenic shock and is supported with an Impella device.”