# Culprit-laesielocatie en uitkomsten van culprit-only vs multivaten-PCI: CULPRIT-SHOCK

*geplaatst 2020-12-01 · Algemeen · JAMA cardiology · doi 10.1001/jamacardio.2020.3377 · https://hartvaat.nl/2020/12/01/culprit-laesielocatie-en-uitkomsten-van-culprit-only-vs-multivaten-pci-culprit-s/*

CULPRIT-SHOCK analyse naar de associatie van culprit-laesielocatie met uitkomsten van culprit-only versus multivaten-PCI.

## English: Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial.

This CULPRIT-SHOCK analysis showed that culprit lesion location (particularly left main or proximal LAD) influences the relative outcomes of culprit-only versus multivessel PCI in cardiogenic shock, informing procedure planning based on anatomy.

## Abstract (original, from the publication)

IMPORTANCE: Myocardial infarction with a culprit lesion located in the left main or proximal left anterior descending artery compared with other coronary segments is associated with more myocardium at risk and worse clinical outcomes. OBJECTIVE: To evaluate the association of culprit lesion location with outcomes of culprit-lesion-only percutaneous coronary intervention with optional staged revascularization vs immediate multivessel percutaneous coronary intervention in patients with multivessel disease, myocardial infarction, and cardiogenic shock. DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of the Culprit Lesion Only Coronary Intervention vs Multivessel Coronary Intervention in Cardiogenic Shock (CULPRIT-SHOCK), an investigator-initiated randomized, open-label clinical trial. Patients with multivessel disease, acute myocardial infarction, and cardiogenic shock were enrolled at 83 European centers from April 2013 through April 2017. INTERVENTIONS: Patients were randomized to culprit-lesion-only percutaneous coronary intervention with optional staged revascularization or immediate multivessel percutaneous coronary intervention (1:1). For this analysis, patients were stratified by culprit lesion location in the left main or proximal left anterior descending artery group and other-culprit-lesion location group. MAIN OUTCOMES AND MEASURES: End points included a composite of death or kidney replacement therapy at 30 days and death at 1 year. RESULTS: The median age of the study population was 70 (interquartile range, 60-78 years) and 524 of the study participants were men (76.4%). Of the 685 patients, 33.4% constituted the left main or proximal left anterior descending artery group and 66.6% the other-culprit-lesion location group. The left main or proximal left anterior descending artery group had worse outcomes compared with the other-culprit-lesion location group (56.8% vs 47.5%; P = .02 for the composite end point at 30 days and 59.8% vs 50.1%; P = .02 for death at 1 year). In both groups, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a reduced risk of the composite end point at 30 days (49.1% vs 64.3% and 44.1% vs 50.9%; P for interaction = .27). At 1 year, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a significantly reduced risk of death in the left main or proximal left anterior descending artery but not the other-culprit-lesion location group (50.0% vs 69.6%; P = .003 and 49.8% vs 50.4%; P = .89; P for interaction = 0.02). CONCLUSIONS AND RELEVANCE: In patients with multivessel disease with myocardial infarction and cardiogenic shock, a culprit lesion located in the left main or proximal left anterior descending artery vs other coronary segments was associated with worse outcomes. These patients may especially benefit from culprit-lesion-only percutaneous coronary intervention with optional staged revascularization, although further investigation is needed to confirm this finding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01927549.

Auteurs: Serdar Farhan, Birgit Vogel, Gilles Montalescot, Olivier Barthelemy, Uwe Zeymer, Steffen Desch, Suzanne de Waha-Thiele, Lars S Maier, Marcus Sandri, Ibrahim Akin, Georg Fuernau, Taoufik Ouarrak, Marie Hauguel-Moreau, Steffen Schneider, Holger Thiele, Kurt Huber

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Bron: JAMA cardiology, https://doi.org/10.1001/jamacardio.2020.3377. Bijgewerkt 2026-07-03T13:28:05Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.