Culprit-only versus complete revascularization (non-CTO) during primary percutaneous intervention in acute STEMI with cardiogenic shock

Abstract

Cardiogenic shock is uncommon in patients with acute myocardial infarction. However, an acute myocardial infarction complicated by cardiogenic shock is a complex syndrome which may induce low cardiac output and hypotension resulting in multi-organ dysfunction and mortality. The mortality rate of acute myocardial infarction complicated by cardiogenic shock after early revascularization, including percutaneous coronary intervention is approximately 40% to 60%. Cardiogenic shock most commonly a result of pump failure that is more prevalent among those with multi-vessel affection. However, it can result from mechanical or arrhythmic complications which require specific management. The management of patients with multi-vessel affection and ST-elevation myocardial infarction presenting with cardiogenic shock remains controversial. Advocates for culprit-only revascularization argue that this strategy shortens the procedure’s timing with less contrast amount and lower contrast induced nephropathy rates. On the other hand, complete revascularization during the primary interventional procedure allows total restoration of myocardial