- Question
- In patients with acute myocardial infarction, cardiogenic shock and multivessel disease, should non-culprit lesions be treated immediately as well, or only the infarct-related artery?
- Design
- Multicenter, randomized, open-label (unmasked) trial in which 706 patients were assigned to one of two initial revascularization strategies. The primary endpoint was assessed at 30 days.
- Population
- Patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease.
- Intervention
- PCI of the culprit lesion only, with the option of staged revascularization of non-culprit lesions at a later stage.
- Control
- Immediate multivessel PCI, i.e., treatment of the culprit lesion and the other significant lesions during the same procedure.
- Primary outcome
- Composite of death or severe renal failure requiring renal-replacement therapy within 30 days after randomization.
- Results
- The primary endpoint occurred in 158 of 344 patients (45.9%) with culprit-lesion-only PCI and in 189 of 341 (55.4%) with multivessel PCI (relative risk 0.83; 95% CI 0.71 to 0.96; P=0.01). The relative risk of death was 0.84 (95% CI 0.72 to 0.98; P=0.03) and that of renal-replacement therapy was 0.71 (95% CI 0.49 to 1.03; P=0.07).
- Safety
- There were no significant differences between groups in the rates of bleeding and stroke.
- Conclusion
- In cardiogenic shock with multivessel disease, initially treating only the culprit lesion lowered the 30-day risk of death or severe renal failure compared with immediate multivessel PCI.
- Why it matters
- The trial challenged the practice of immediately revascularizing all lesions in patients with cardiogenic shock and supported limiting the acute procedure to the infarct-related artery.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026