Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial

CULPRIT-SHOCK Trial Investigators, Steering Committee

doi:10.1016/j.chest.2020.10.089

Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial

CULPRIT-SHOCK Trial Investigators, Steering Committee

Sorbonne Université
Heidelberg University
Leipzig University
University Heart Centre Luebeck, Department of Cardiology, Angiology and Intensive Care Medicine, Luebeck
Leeds Teaching Hospitals NHS Trust
3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical School, Vienna, Austria
University of Ljubljana
Golden Jubilee National Hospital
Statistician Unit, StatEthic, Levallois-Perret, France
Alessandro Manzoni Hospital
Vilnius University
Cardinal Stefan Wyszynski Institute of Cardiology
Université Paris 7
University of Antwerp
University of Bern
Heart Centre Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. Research Question: In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? Study Design and Methods: Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. Results: Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P =.015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P =.85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P =.36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P =.42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P =.12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P =.91 and P =.97 for interaction). Interpretation: In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.

Original language	English
Pages (from-to)	1415-1425
Number of pages	11
Journal	Chest
Volume	159
Issue number	4
Early online date	26 Nov 2020
DOIs	https://doi.org/10.1016/j.chest.2020.10.089
Publication status	Published - 1 Apr 2021

Keywords

NSTEMI
STEMI
cardiogenic shock
left bundle branch block
percutaneous coronary intervention

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10.1016/j.chest.2020.10.089

Clinical-outcomes-according-to-ecg-presentations-in-infarct-related-cardiogenic-shock-in-the-culprit-lesion-only-pci-vs-.pdfFinal published version, 516 KBLicence: Taverne

Cite this

@article{fe41e0ccb0d94b5e9bc11ad2a27c346d,

title = "Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial",

abstract = "Background: The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. Research Question: In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? Study Design and Methods: Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. Results: Of 665 cardiogenic shock patients analyzed, 55.9\% demonstrated STEMI, 29.3\% demonstrated NSTEMI, and 14.7\% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P =.015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7\% vs 43.0\%; adjusted OR [aOR], 1.05; 95\% CI, 0.66-1.67; P =.85), nor between LBBBMI and STEMI patients (59.2\% vs 43.0\%; aOR, 1.31; 95\% CI, 0.73-2.34; P =.36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4\% vs 46.8\%; aOR, 1.21; 95\% CI, 0.76-1.92; P =.42; LBBBMI vs STEMI: 69.4\% vs 46.8\%; aOR, 1.59; 95\% CI, 0.89-2.84; P =.12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P =.91 and P =.97 for interaction). Interpretation: In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.",

keywords = "NSTEMI, STEMI, cardiogenic shock, left bundle branch block, percutaneous coronary intervention",

author = "Michel Zeitouni and Ibrahim Akin and \{CULPRIT-SHOCK Trial Investigators, Steering Committee\} and Steffen Desch and Olivier Barth{\'e}l{\'e}my and Delphine Brugier and Jean-Philippe Collet and \{de Waha-Thiele\}, Suzanne and Greenwood, \{John P.\} and Paul Guedeney and Georges Hage and Marie Hauguel-Moreau and Kurt Huber and Mathieu Kerneis and Marko Noc and Oldroyd, \{Keith G.\} and Piek, \{Jan J.\} and St{\'e}phanie Rouanet and Stefano Savonitto and Pranas Serpytis and Johanne Silvain and Janina Stepinska and Eric Vicaut and Vrints, \{Christiaan J. M.\} and Stephan Windecker and Uwe Zeymer and Holger Thiele and Gilles Montalescot and Patrizia Torremante and Roza Meyer-Saraei and Ulrich Tebbe and Jochen W{\"o}hrle and Otmar Pachinger and Clemens Busch and Nathalie Pfeiffer and Alexander Neumer and Steffen Schneider and Taoufik Ouarrak and Thomas Reimer and Christiane Lober and Peter Clemmensen and Ferenc Follath and Karl Wegscheider and O. Barth{\'e}l{\'e}my and M. Zeitouni and P. Overtchouk and P. Guedeney and G. Hage and Hauguel-Moreau",

note = "Funding Information: FUNDING/SUPPORT: The CULPRIT-SHOCK trial was supported by the European Union Seventh Framework Program [Grant 602202], by the German Heart Research Foundation, and the German Cardiac Society.Author contributions: M. Z. G. M. and H. T. designed the study; gathered and analyzed the data; and drafted the manuscript. S. R. and E. V. provided an independent statistical analysis, results, and revision. The other authors contributed to data gathering, biological measurements, and critical revision of the manuscript. All the authors vouch for the data and analyses reported. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. Z. has received research grants from Institut Servier, Federation Fran?aise de Cardiologie, and lecture fees from BMS/Pfizer. J.-P. C. has received research grants from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eli-Lilly, F?d?ration Fran?aise de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. K. H. has received research grants form AstraZeneca and Sanofi as well as lecture fees form AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Sanofi, and the Medicines Company. M. K. has received research grants from F?f?ration Francaise de Cardiologie and Institut Servier and consulting fees from Sanofi and Servier. K. G. O. has received speaker or consultancy fees, or both, from Abbott Vascular, Boston Scientific, Biosensors, and MedAlliance. J. J. P. has received consultant fees from Philips/Volcano. S. S. has received research grants (to his institution) from Eli-Lilly, Daiichi Sankyo, and Novartis and speaker or advisory board fees from Bayer, Astra-Zeneca, and Abbott. J. Silvain has received consulting fees or lecture fees or travel support from AstraZeneca, Bayer HealthCare SAS, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Terumo France SAS,Abbott Medical France SAS, and Stockholder of Pharmaseeds. J. Stepinska has received research grants from Amed, Amgen, Algorythm, Astra-Zeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Fondation de France, Gilead Science, Iroko Cardio, Sanofi-Aventis, and Saint-Jude Medical. J. Stepinska has received research grants from Bayer and Sanofi and consulting or lecture fees from, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, Sanofi, and Servier. E. V. reports receiving personal fees from Eli Lilly; is a consultant for Pfizer, Sanofi, LFB, Abbott, Fresenius, Medtronic, and Hexacath; is member of data safety monitoring board for CERC; has received lecture fees from Novartis; and has received grants from Boehringer and Sanofi. S. W. has received research and educational grants from Abbott, Amgen, Bayer, BMS, CSL Behring, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Polares, and Sinomed. U. Z. has received research grants or consulting fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Ferrer, Idorsia, Medicines Company, Medtronic, MSD, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. G. M. has received research grants or consulting fees from Abbott, Amgen, Actelion, American College of Cardiology Foundation, AstraZeneca, Axis-Sant?, Bayer, Boston-Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women's Hospital, China Heart House, Daiichi-Sankyo, Idorsia, Elsevier, Europa, F?d?ration Fran?aise de Cardiologie, ICAN, Lead-Up, Medtronic, Menarini, MSD, Novo-Nordisk, Partners, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. None declared (I. A. O. B. D. B. S. de W.-T. J. P. G. P. G. G. H. M. H.-M. M. N. S. R. S. D. P. S. C. J. M. V. H. T.). ?CULPRIT-SHOCK Trial Investigators: Steering Committee: Holger Thiele (principal investigator and chair), Heart Center Leipzig ? University Hospital, Leipzig, Germany; Steffen Desch, Heart Center Leipzig ? University Hospital, Leipzig, Germany; Uwe Zeymer, Klinikum Ludwigshafen and Institut f?r Herzinfarktforschung, Ludwigshafen, Germany; Gilles Montalescot, ACTION group, Paris, France; Jan J. Piek, Academic Medical Center, Amsterdam, The Netherlands; Patrizia Torremante, ARTTIC, Munich, Germany. Project Management: Patrizia Torremante, ARTTIC, Munich, Germany; Roza Meyer-Saraei, University Hospital Schleswig-Holstein, L?beck, Germany. Clinical Endpoints Committee: Ulrich Tebbe (chair), Detmold, Germany; Jochen W?hrle, University of Ulm, Germany; Otmar Pachinger, University of nnsbruck, Innsbruck, Austria. Data Monitoring: Institut f?r Herzinfarktforschung, Ludwigshafen, Germany: Clemens Busch (chair); Nathalie Pfeiffer. Data Management: Institut f?r Herzinfarktforschung, Ludwigshafen, Germany: Alexander Neumer, Clemens Busch, Nathalie Pfeiffer. Data Coordination and Analysis: Institut f?r Herzinfarktforschung, Ludwigshafen, Germany: Steffen Schneider (chair statistics); Taoufik Ouarrak (statistics), Thomas Reimer (statistics), Christiane Lober (statistics). Data Safety Monitoring Board: Peter Clemmensen, MD (chair), Universit?res Herzzentrum Hamburg, Hamburg, Germany; Ferenc Follath, MD, University of Zurich, Zurich, Switzerland; Karl Wegscheider, Universit?tsklinikum Hamburg-Eppendorf, Hamburg, Germany. Angiographic Core Laboratory Committee (ACLC) at the ACTION Study Group: Dr O. Barth?l?my (chair), Dr M. Zeitouni, Dr P. Overtchouk, Dr P. Guedeney, Dr G. Hage, Dr Hauguel-Moreau. Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Table can be found in the Supplemental Materials section of the online article. Funding Information: FUNDING/SUPPORT: The CULPRIT-SHOCK trial was supported by the European Union Seventh Framework Program [Grant 602202], by the German Heart Research Foundation, and the German Cardiac Society. Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. Z. has received research grants from Institut Servier, Federation Fran{\c c}aise de Cardiologie, and lecture fees from BMS/Pfizer. J.-P. C. has received research grants from AstraZeneca , Bayer , Bristol-Myers Squibb , Daiichi-Sankyo , Eli-Lilly, F{\'e}d{\'e}ration Fran{\c c}aise de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. K. H. has received research grants form AstraZeneca and Sanofi as well as lecture fees form AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Sanofi, and the Medicines Company. M. K. has received research grants from F{\'e}f{\'e}ration Francaise de Cardiologie and Institut Servier and consulting fees from Sanofi and Servier. K. G. O. has received speaker or consultancy fees, or both, from Abbott Vascular, Boston Scientific, Biosensors, and MedAlliance. J. J. P. has received consultant fees from Philips/Volcano. S. S. has received research grants (to his institution) from Eli-Lilly, Daiichi Sankyo, and Novartis and speaker or advisory board fees from Bayer, Astra-Zeneca, and Abbott. J. Silvain has received consulting fees or lecture fees or travel support from AstraZeneca, Bayer HealthCare SAS, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Terumo France SAS,Abbott Medical France SAS, and Stockholder of Pharmaseeds. J. Stepinska has received research grants from Amed, Amgen, Algorythm, Astra-Zeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Fondation de France, Gilead Science, Iroko Cardio, Sanofi-Aventis, and Saint-Jude Medical. J. Stepinska has received research grants from Bayer and Sanofi and consulting or lecture fees from, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis , Pfizer , Sanofi, and Servier. E. V. reports receiving personal fees from Eli Lilly; is a consultant for Pfizer, Sanofi, LFB, Abbott, Fresenius, Medtronic, and Hexacath; is member of data safety monitoring board for CERC; has received lecture fees from Novartis; and has received grants from Boehringer and Sanofi. S. W. has received research and educational grants from Abbott, Amgen, Bayer, BMS, CSL Behring, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Polares, and Sinomed. U. Z. has received research grants or consulting fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Ferrer, Idorsia, Medicines Company, Medtronic, MSD, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. G. M. has received research grants or consulting fees from Abbott, Amgen, Actelion, American College of Cardiology Foundation , AstraZeneca, Axis-Sant{\'e}, Bayer, Boston-Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women{\textquoteright}s Hospital, China Heart House, Daiichi-Sankyo, Idorsia, Elsevier, Europa, F{\'e}d{\'e}ration Fran{\c c}aise de Cardiologie , ICAN, Lead-Up, Medtronic, Menarini, MSD, Novo-Nordisk, Partners, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. None declared (I. A., O. B., D. B., S. de W.-T., J. P. G., P. G., G. H., M. H.-M., M. N., S. R., S. D., P. S., C. J. M. V., H. T.). Publisher Copyright: {\textcopyright} 2020 American College of Chest Physicians",

year = "2021",

month = apr,

day = "1",

doi = "10.1016/j.chest.2020.10.089",

language = "English",

volume = "159",

pages = "1415--1425",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "4",

}

TY - JOUR

T1 - Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial

AU - Zeitouni, Michel

AU - Akin, Ibrahim

AU - CULPRIT-SHOCK Trial Investigators, Steering Committee

AU - Desch, Steffen

AU - Barthélémy, Olivier

AU - Brugier, Delphine

AU - Collet, Jean-Philippe

AU - de Waha-Thiele, Suzanne

AU - Greenwood, John P.

AU - Guedeney, Paul

AU - Hage, Georges

AU - Hauguel-Moreau, Marie

AU - Huber, Kurt

AU - Kerneis, Mathieu

AU - Noc, Marko

AU - Oldroyd, Keith G.

AU - Piek, Jan J.

AU - Rouanet, Stéphanie

AU - Savonitto, Stefano

AU - Serpytis, Pranas

AU - Silvain, Johanne

AU - Stepinska, Janina

AU - Vicaut, Eric

AU - Vrints, Christiaan J. M.

AU - Windecker, Stephan

AU - Zeymer, Uwe

AU - Thiele, Holger

AU - Montalescot, Gilles

AU - Torremante, Patrizia

AU - Meyer-Saraei, Roza

AU - Tebbe, Ulrich

AU - Wöhrle, Jochen

AU - Pachinger, Otmar

AU - Busch, Clemens

AU - Pfeiffer, Nathalie

AU - Neumer, Alexander

AU - Schneider, Steffen

AU - Ouarrak, Taoufik

AU - Reimer, Thomas

AU - Lober, Christiane

AU - Clemmensen, Peter

AU - Follath, Ferenc

AU - Wegscheider, Karl

AU - Barthélémy, O.

AU - Zeitouni, M.

AU - Overtchouk, P.

AU - Guedeney, P.

AU - Hage, G.

AU - Hauguel-Moreau, null

N1 - Funding Information: FUNDING/SUPPORT: The CULPRIT-SHOCK trial was supported by the European Union Seventh Framework Program [Grant 602202], by the German Heart Research Foundation, and the German Cardiac Society.Author contributions: M. Z. G. M. and H. T. designed the study; gathered and analyzed the data; and drafted the manuscript. S. R. and E. V. provided an independent statistical analysis, results, and revision. The other authors contributed to data gathering, biological measurements, and critical revision of the manuscript. All the authors vouch for the data and analyses reported. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. Z. has received research grants from Institut Servier, Federation Fran?aise de Cardiologie, and lecture fees from BMS/Pfizer. J.-P. C. has received research grants from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eli-Lilly, F?d?ration Fran?aise de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. K. H. has received research grants form AstraZeneca and Sanofi as well as lecture fees form AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Sanofi, and the Medicines Company. M. K. has received research grants from F?f?ration Francaise de Cardiologie and Institut Servier and consulting fees from Sanofi and Servier. K. G. O. has received speaker or consultancy fees, or both, from Abbott Vascular, Boston Scientific, Biosensors, and MedAlliance. J. J. P. has received consultant fees from Philips/Volcano. S. S. has received research grants (to his institution) from Eli-Lilly, Daiichi Sankyo, and Novartis and speaker or advisory board fees from Bayer, Astra-Zeneca, and Abbott. J. Silvain has received consulting fees or lecture fees or travel support from AstraZeneca, Bayer HealthCare SAS, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Terumo France SAS,Abbott Medical France SAS, and Stockholder of Pharmaseeds. J. Stepinska has received research grants from Amed, Amgen, Algorythm, Astra-Zeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Fondation de France, Gilead Science, Iroko Cardio, Sanofi-Aventis, and Saint-Jude Medical. J. Stepinska has received research grants from Bayer and Sanofi and consulting or lecture fees from, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, Sanofi, and Servier. E. V. reports receiving personal fees from Eli Lilly; is a consultant for Pfizer, Sanofi, LFB, Abbott, Fresenius, Medtronic, and Hexacath; is member of data safety monitoring board for CERC; has received lecture fees from Novartis; and has received grants from Boehringer and Sanofi. S. W. has received research and educational grants from Abbott, Amgen, Bayer, BMS, CSL Behring, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Polares, and Sinomed. U. Z. has received research grants or consulting fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Ferrer, Idorsia, Medicines Company, Medtronic, MSD, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. G. M. has received research grants or consulting fees from Abbott, Amgen, Actelion, American College of Cardiology Foundation, AstraZeneca, Axis-Sant?, Bayer, Boston-Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women's Hospital, China Heart House, Daiichi-Sankyo, Idorsia, Elsevier, Europa, F?d?ration Fran?aise de Cardiologie, ICAN, Lead-Up, Medtronic, Menarini, MSD, Novo-Nordisk, Partners, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. None declared (I. A. O. B. D. B. S. de W.-T. J. P. G. P. G. G. H. M. H.-M. M. N. S. R. S. D. P. S. C. J. M. V. H. T.). ?CULPRIT-SHOCK Trial Investigators: Steering Committee: Holger Thiele (principal investigator and chair), Heart Center Leipzig ? University Hospital, Leipzig, Germany; Steffen Desch, Heart Center Leipzig ? University Hospital, Leipzig, Germany; Uwe Zeymer, Klinikum Ludwigshafen and Institut f?r Herzinfarktforschung, Ludwigshafen, Germany; Gilles Montalescot, ACTION group, Paris, France; Jan J. Piek, Academic Medical Center, Amsterdam, The Netherlands; Patrizia Torremante, ARTTIC, Munich, Germany. Project Management: Patrizia Torremante, ARTTIC, Munich, Germany; Roza Meyer-Saraei, University Hospital Schleswig-Holstein, L?beck, Germany. Clinical Endpoints Committee: Ulrich Tebbe (chair), Detmold, Germany; Jochen W?hrle, University of Ulm, Germany; Otmar Pachinger, University of nnsbruck, Innsbruck, Austria. Data Monitoring: Institut f?r Herzinfarktforschung, Ludwigshafen, Germany: Clemens Busch (chair); Nathalie Pfeiffer. Data Management: Institut f?r Herzinfarktforschung, Ludwigshafen, Germany: Alexander Neumer, Clemens Busch, Nathalie Pfeiffer. Data Coordination and Analysis: Institut f?r Herzinfarktforschung, Ludwigshafen, Germany: Steffen Schneider (chair statistics); Taoufik Ouarrak (statistics), Thomas Reimer (statistics), Christiane Lober (statistics). Data Safety Monitoring Board: Peter Clemmensen, MD (chair), Universit?res Herzzentrum Hamburg, Hamburg, Germany; Ferenc Follath, MD, University of Zurich, Zurich, Switzerland; Karl Wegscheider, Universit?tsklinikum Hamburg-Eppendorf, Hamburg, Germany. Angiographic Core Laboratory Committee (ACLC) at the ACTION Study Group: Dr O. Barth?l?my (chair), Dr M. Zeitouni, Dr P. Overtchouk, Dr P. Guedeney, Dr G. Hage, Dr Hauguel-Moreau. Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Table can be found in the Supplemental Materials section of the online article. Funding Information: FUNDING/SUPPORT: The CULPRIT-SHOCK trial was supported by the European Union Seventh Framework Program [Grant 602202], by the German Heart Research Foundation, and the German Cardiac Society. Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. Z. has received research grants from Institut Servier, Federation Française de Cardiologie, and lecture fees from BMS/Pfizer. J.-P. C. has received research grants from AstraZeneca , Bayer , Bristol-Myers Squibb , Daiichi-Sankyo , Eli-Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. K. H. has received research grants form AstraZeneca and Sanofi as well as lecture fees form AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Sanofi, and the Medicines Company. M. K. has received research grants from Féfération Francaise de Cardiologie and Institut Servier and consulting fees from Sanofi and Servier. K. G. O. has received speaker or consultancy fees, or both, from Abbott Vascular, Boston Scientific, Biosensors, and MedAlliance. J. J. P. has received consultant fees from Philips/Volcano. S. S. has received research grants (to his institution) from Eli-Lilly, Daiichi Sankyo, and Novartis and speaker or advisory board fees from Bayer, Astra-Zeneca, and Abbott. J. Silvain has received consulting fees or lecture fees or travel support from AstraZeneca, Bayer HealthCare SAS, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Terumo France SAS,Abbott Medical France SAS, and Stockholder of Pharmaseeds. J. Stepinska has received research grants from Amed, Amgen, Algorythm, Astra-Zeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Fondation de France, Gilead Science, Iroko Cardio, Sanofi-Aventis, and Saint-Jude Medical. J. Stepinska has received research grants from Bayer and Sanofi and consulting or lecture fees from, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis , Pfizer , Sanofi, and Servier. E. V. reports receiving personal fees from Eli Lilly; is a consultant for Pfizer, Sanofi, LFB, Abbott, Fresenius, Medtronic, and Hexacath; is member of data safety monitoring board for CERC; has received lecture fees from Novartis; and has received grants from Boehringer and Sanofi. S. W. has received research and educational grants from Abbott, Amgen, Bayer, BMS, CSL Behring, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Polares, and Sinomed. U. Z. has received research grants or consulting fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Ferrer, Idorsia, Medicines Company, Medtronic, MSD, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. G. M. has received research grants or consulting fees from Abbott, Amgen, Actelion, American College of Cardiology Foundation , AstraZeneca, Axis-Santé, Bayer, Boston-Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, China Heart House, Daiichi-Sankyo, Idorsia, Elsevier, Europa, Fédération Française de Cardiologie , ICAN, Lead-Up, Medtronic, Menarini, MSD, Novo-Nordisk, Partners, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. None declared (I. A., O. B., D. B., S. de W.-T., J. P. G., P. G., G. H., M. H.-M., M. N., S. R., S. D., P. S., C. J. M. V., H. T.). Publisher Copyright: © 2020 American College of Chest Physicians

PY - 2021/4/1

Y1 - 2021/4/1

N2 - Background: The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. Research Question: In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? Study Design and Methods: Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. Results: Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P =.015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P =.85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P =.36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P =.42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P =.12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P =.91 and P =.97 for interaction). Interpretation: In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.

AB - Background: The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. Research Question: In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? Study Design and Methods: Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. Results: Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P =.015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P =.85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P =.36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P =.42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P =.12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P =.91 and P =.97 for interaction). Interpretation: In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.

KW - NSTEMI

KW - STEMI

KW - cardiogenic shock

KW - left bundle branch block

KW - percutaneous coronary intervention

UR - https://www.scopus.com/pages/publications/85103099218

U2 - 10.1016/j.chest.2020.10.089

DO - 10.1016/j.chest.2020.10.089

M3 - Article

C2 - 33248059

SN - 0012-3692

VL - 159

SP - 1415

EP - 1425

JO - Chest

JF - Chest

IS - 4

ER -

Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial

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