title: Culprit lesion location and outcome in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial.
abstract: BACKGROUND
  In myocardial infarction without cardiogenic shock (CS), the affected coronary vessel has significant influence on the final infarct size and patient prognosis. CS data on this relation are scarce. The objective of this study was to determine the prognostic relevance of the culprit lesion location in patients with CS complicating acute myocardial infarction.
  
  
  METHODS
  In the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial patients with CS were randomized to therapy with intraaortic balloon pump or control. Additional CS patients not eligible for the randomized trial were included in a registry. We compared the location of the culprit lesions in these patients with regard to the affected coronary vessel [left main (LM), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA)] and location within the vessel (proximal, mid or distal) regarding short- and long-term outcome.
  
  
  RESULTS
  Of 758 patients, the majority had the culprit lesion in the LAD (44 %) compared to RCA (27 %), LCX (19 %) or LM (10 %). Proximal lesions were more frequent than mid or distal culprit lesions (60 vs. 27 vs. 13 %, p < 0.001). No differences were observed for mortality with respect to either culprit vessel (log-rank p value = 0.54). In contrast, a higher mortality was observed for patients with distal culprit lesions after 1 year (log-rank p value = 0.04). This difference persisted after multivariable adjustment (hazard ratio for distal lesions 1.40; 95 % confidential interval 1.03-1.90; p = 0.03).
  
  
  CONCLUSIONS
  For patients with CS complicating myocardial infarction, the culprit vessel seems to be unrelated with mortality whereas distal culprit lesions may have a worse outcome.
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany. georg.fuernau@uksh.de.|Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany. georg.fuernau@uksh.de.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. georg.fuernau@uksh.de.
authors.forename: Georg
authors.identifier: http://orcid.org/0000-0002-3813-8772
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Fengler
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Cardiology, Bad Krozingen Heart Center, University of Freiburg, Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: Department of Internal Medicine I, Hospital Langen, Langen, Germany.
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Olbrich
authors.affiliation: Department of Cardiology, German Heart Center Munich, Munich, Germany.
authors.forename: Antoinette
authors.initials: A
authors.lastname: de Waha
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: Department of Cardiology/Angiology, Bad Segeberg Heart Center, Bad Segeberg, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.affiliation: Department of Internal Medicine I, Klinikum am Gesundbrunnen, Heilbronn, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Hennersdorf
authors.affiliation: Department of Internal Medicine B, University of Greifswald, Greifswald, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Empen
authors.affiliation: Department of Cardiology/Angiology, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine III, University of Homburg, Homburg/Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.affiliation: Clinic for Internal Medicine/Cardiology, University of Dresden-Heart Center, Dresden, Germany.
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Strasser
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Taoufik
authors.initials: T
authors.lastname: Ouarrak
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiogenic shock; Culprit lesion; Infarct-related artery; Mortality; Myocardial infarction