title: Multivessel versus culprit lesion only percutaneous revascularization plus potential staged revascularization in patients with acute myocardial infarction complicated by cardiogenic shock: Design and rationale of CULPRIT-SHOCK trial.
abstract: BACKGROUND
  In acute myocardial infarction complicated by cardiogenic shock (CS), up to 80% of patients present with multivessel coronary artery disease. Currently, the best revascularization strategy is unknown. Therefore, a prospective randomized adequately powered clinical trial is warranted.
  
  
  METHODS
  The CULPRIT-SHOCK study is a 706-patient controlled, international, multicenter, randomized, open-label trial. It is designed to compare culprit lesion only percutaneous coronary intervention (PCI) with possible staged non-culprit lesion revascularization versus immediate multivessel PCI in patients with CS complicating acute myocardial infarction. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoint of CULPRIT-SHOCK is 30-day mortality and severe renal failure requiring renal replacement therapy. Secondary outcome measures such as hemodynamic, laboratory, and clinical parameters will serve as surrogate endpoints for prognosis. Furthermore, an intermediate- and long-term follow-up at 6 and 12 months will be performed. Safety endpoints include the assessment of bleeding and stroke.
  
  
  CONCLUSIONS
  The CULPRIT-SHOCK trial will address the question of optimal revascularization strategy in patients with multivessel disease and acute myocardial infarction complicated by CS.
authors: University Heart Center Luebeck, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Luebeck, Germany. Electronic address: holger.thiele@uksh.de.
authors: Holger
authors: H
authors: Thiele
authors: University Heart Center Luebeck, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Luebeck, Germany.
authors: Steffen
authors: S
authors: Desch
authors: Academic Medical Center, Amsterdam, The Netherlands.
authors: Jan J
authors: JJ
authors: Piek
authors: Institute of Cardiology, Warsaw, Poland.
authors: Janina
authors: J
authors: Stepinska
authors: Western Infirmary, Glasgow, UK.
authors: Keith
authors: K
authors: Oldroyd
authors: Vilnius University Hospital, Vilnius, Lithuania.
authors: Pranas
authors: P
authors: Serpytis
authors: ACTION study group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
authors: Gilles
authors: G
authors: Montalescot
authors: University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Marko
authors: M
authors: Noc
authors: Wilhelminenspital der Stadt Wien, Vienna, Austria.
authors: Kurt
authors: K
authors: Huber
authors: University Heart Center Luebeck, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Luebeck, Germany.
authors: Georg
authors: G
authors: Fuernau
authors: University Heart Center Luebeck, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Luebeck, Germany.
authors: Suzanne
authors: S
authors: de Waha
authors: University Heart Center Luebeck, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Luebeck, Germany.
authors: Roza
authors: R
authors: Meyer-Saraei
authors: Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors: Steffen
authors: S
authors: Schneider
authors: University of Bern, Inselspital, Bern, Switzerland.
authors: Stephan
authors: S
authors: Windecker
authors: Manzoni Hospital, Lecco, Italy.
authors: Stefano
authors: S
authors: Savonitto
authors: Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
authors: Andrew
authors: A
authors: Briggs
authors: GABO:milliarium mbH & Co KG, Munich, Germany.
authors: Patrizia
authors: P
authors: Torremante
authors: Universitair Ziekenhuis Antwerp, Antwerp, Belgium.
authors: Christiaan
authors: C
authors: Vrints
authors: University of Leipzig-Heart Center, Leipzig, Germany.
authors: Gerhard
authors: G
authors: Schuler
authors: University of Leipzig-Institute of Laboratory Medicine, Leipzig, Germany.
authors: Uta
authors: U
authors: Ceglarek
authors: University of Leipzig-Institute of Laboratory Medicine, Leipzig, Germany.
authors: Joachim
authors: J
authors: Thiery
authors: Institut für Herzinfarktforschung, Ludwigshafen, Germany; Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors: Uwe
authors: U
authors: Zeymer
mesh_terms: D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome