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Georg Fuernau, Holger Thiele
Medical Clinic II-Department of Cardiology, Angiology and Intensive
Care Medicine, University Heart Center Luebeck, University of Luebeck,
Keywords: acute myocardial infarction, cardiogenic shock, multivessel
percutaneous coronary intervention
Georg Fuernau, M.D.
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)...
Georg Fuernau, M.D.
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)
University Heart Center Luebeck
University Hospital Schleswig-Holstein, Ratzeburger Allee 160
23538 Luebeck, Germany
Tel.: +49 451 500 2501; Fax: +49 451 500 6437
We read with great interest the manuscript by Park and co-workers
published epub ahead of print in Heart . The authors investigated an
important and controversial issue, interventional treatment of multi-
vessel disease in patients with cardiogenic shock complicating acute
myocardial infarction. Yet, we have some concerns if the population
studied in this manuscript reflects a population with real cardiogenic
shock. Although using established definitions for cardiogenic shock
(systolic blood pressure <90 mmHg for >30 min or the need for
supportive management to maintain systolic blood pressure >90 mmHg and
evidence of end-organ hypoperfusion) the one-year mortality (~16%) in the
study by Park et al. was much lower than in all other studies
investigating cardiogenic shock. In other trials mortality rates of 50% up
to 63% after 1 year were reported [2, 3]. Therefore, we believe that the
population studied is a cohort at minor risk and the results cannot be
extrapolated to patients with severe cardiogenic shock. Furthermore, the
discussion is slightly selective with not all trials being cited comparing
multi-vessel versus culprit lesion only PCI in cardiogenic shock. The
current evidence has recently been reviewed . To clarify the important
question of multi-vessel vs. culprit lesion percutaneous coronary
intervention in patients with cardiogenic shock complicating myocardial
infarction a randomized European multi-center study is currently
recruiting patients (Culprit Lesion Only PCI Versus Multivessel PCI in
Cardiogenic Shock - CULPRIT-SHOCK; ClinicalTrials.gov Identifier:
Conflict of Interest:
1 Park JS, Cha KS, Lee DS, et al. Culprit or multivessel
revascularisation in ST-elevation myocardial infarction with cardiogenic
shock. Heart 2015. pii: heartjnl-2014-307220. doi: 10.1136/heartjnl-2014-
307220. [Epub ahead of print].
2 Thiele H, Zeymer U, Neumann FJ, et al. Intra-aortic balloon
counterpulsation in acute myocardial infarction complicated by cardiogenic
shock (IABP-SHOCK II): final 12 month results of a randomised, open-label
trial. Lancet 2013;382:1638-45.
3 Aissaoui N, Puymirat E, Tabone X, et al. Improved outcome of
cardiogenic shock at the acute stage of myocardial infarction: a report
from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries.
Eur Heart J 2012;33:2535-43.
4 Thiele H, Ohman EM, Desch S, et al. Management of cardiogenic
shock. Eur Heart J 2015. pii: ehv051. [Epub ahead of print].