Culprit Only versus Total Revascularization in Acute Coronary Syndrome Patients Presented with Cardiogenic Shock with Multivessel Disease

Document Type : Original research articles

Author

Cardiology Department, Faculty of Medicine Al- Azhar University (Assiut Branch), Assiut, Egypt

Abstract

 
Background: Acute coronary syndrome (ACS) with multivessel disease )MVD( and cardiogenic shock (CS) represents a higher cardiovascular risk, and revascularization strategy in such patients remains a subject of conflict.
Objectives: This work investigated total revascularization benefits and safety compared to culprit-only revascularization in ACS, MVD, and CS patients.
Patients and methods: This prospective randomized study was performed on 130 patients, aged ≥ 18 years old, both sexes, with ACS with MVD and CS and diagnosed with significant lesions (>70% stenosis in the major coronary vessel) in one or more coronary vessels. Patients were grouped into two equal groups: patients undergoing culprit revascularization in Group CR and those undergoing total revascularization in Group TR.
Results: Procedure time, the number of stents and contrast used, and left ventricular ejection fraction were significantly increased in group TR compared with group CR (P <0.001). Cardiac mortality in hospitals, at 1m, 6m, and 1y, were insignificantly different between groups. Repeat myocardial infraction (MI) /ACS at 1m, 6m, and 1y were comparable between both groups. All cause mortality, repeat MI /ACS, and revascularization at 1y were significantly decreased in group TR compared with group CR (P <0.05).
Conclusions: In ACS with MVD and CS, total revascularization is superior to culprit-only revascularization, as evidenced by better cardiac motility, lower all cause mortality, total repeat MI /ACS, and revascularization incidence.

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SVU-International Journal of Medical Sciences
Volume 8, Issue 1
January -June
January 2025
Pages 444-451

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