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Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01927549
First Posted: August 22, 2013
Last Update Posted: November 9, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborators:
European Commission
German Cardiac Society
Deutsche Stiftung für Herzforschung
Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)
Information provided by (Responsible Party):
Holger Thiele, Heartcenter Leipzig GmbH
  Purpose

The study compares the therapies of instant multivessel balloon angioplasty plus stent implantation or the balloon angioplasty plus stent implantation of the infarct artery alone with any possible graduated later treatment of the other vessels in patients with acute myocardial infarction with cardioganic shock.

The main study hypothesis is to explore if culprit vessel only PCI with potentially subsequent staged revascularization in comparison to immediate multivessel revascularization by PCI in patients with cardiogenic shock complicating acute myocardial infarction reduces the incidence of 30- day mortality and/or severe renal failure requiring renal replacement therapy.


Condition Intervention Phase
Cardiogenic Shock Acute Myocardial Infarction Complications Procedure: Immediate multivessel PCI Procedure: Culprit Lesion only PCI Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Prospective Randomized Multicenter Study Comparing Immediate Multivessel Revascularization by PCI Versus Culprit Lesion PCI With Staged Non-culprit Lesion Revascularization in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

Resource links provided by NLM:


Further study details as provided by Holger Thiele, Heartcenter Leipzig GmbH:

Primary Outcome Measures:
  • 30-day mortality and/or severe renal failure requiring renal replacement therapy [ Time Frame: 30 days ]

Secondary Outcome Measures:
  • 30-day mortality [ Time Frame: 30 days ]
  • Requirement of renal replacement therapy [ Time Frame: 30 days ]
  • Time to hemodynamic stabilization [ Time Frame: 30 days ]
  • Duration of catecholamine therapy [ Time Frame: 30 days ]
  • Serial creatinine-level creatinine-clearance [ Time Frame: 30 days ]
  • Length of ICU-stay [ Time Frame: 30 days ]
  • Serial intensive care scoring (SAPS-II score) until stabilization [ Time Frame: 30 days ]
  • Requirement and length of mechanical ventilation [ Time Frame: 30 days ]
  • All-cause death within 12 months follow-up [ Time Frame: 12 months ]
  • Recurrent infarction within 30-days follow-up [ Time Frame: 30 days ]
  • Death or recurrent infarction at 12 months follow-up [ Time Frame: 12 months ]
  • Rehospitalization for congestive heart failure within 12 months follow-up [ Time Frame: 12 months ]
  • Death/recurrent infarction/rehospitalization for congestive heart failure within 12 months [ Time Frame: 12 months ]
  • Need for repeat revascularization (PCI and/or CABG) within 12 months follow-up [ Time Frame: 12 months ]
  • Peak creatine kinase level during hospital stay [ Time Frame: 30 days ]
  • Quality of life at 6 and 12 months assessed using Euroqol 5D (EQ-5D) [ Time Frame: 12 months ]
  • Maximum creatine kinase-MB level [ Time Frame: 30 days ]
  • Maximum troponin level [ Time Frame: 30 days ]
  • Recurrent infarction within 12 months follow-up [ Time Frame: 12 months ]

Enrollment: 706
Study Start Date: April 2013
Study Completion Date: October 2017
Primary Completion Date: July 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Immediate multivessel PCI
After diagnostic angiography the culprit lesion is identified and PCI should be performed using standard techniques. The use of drug-eluting stents is recommended but not mandatory. All additional lesions in other major coronary arteries defined by a diameter >2 mm with high grade stenoses (>70% by visual assessment) should be intervened using standard techniques. Other major coronary arteries are defined by stenoses of other vessels and are not confined to a diagonal branch if the left anterior descending coronary artery was identified as the culprit lesion.
Procedure: Immediate multivessel PCI
Active Comparator: Culprit lesion only PCI
After diagnostic angiography the culprit lesion is identified and PCI of the culprit lesion should be performed using standard techniques. The use of drug-eluting stents is recommended but not mandatory. All other lesions should be left untreated in the acute setting. Complete revascularization of the non-culprit lesions may be performed at a later time point as staged procedure depending on remaining ischemia (as per guideline recommendations either by PCI or CABG).
Procedure: Culprit Lesion only PCI

  Eligibility

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Ages Eligible for Study:   18 Years to 90 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Cardiogenic shock complicating acute myocardial infarction (STEMI or NSTEMI) with obligatory:

I) Planned early revascularization by PCI II) Multivessel coronary artery disease defined as more than 70% stenosis in at least 2 major vessels (more than 2 mm diameter) with identifiable culprit lesion III)

  1. Systolic blood pressure less than 90 mmHg for more than 30 min or
  2. catecholamines required to maintain pressure more than 90 mmHg during systole and IV) Signs of pulmonary congestion V) Signs of impaired organ perfusion with at least one of the following criteria

a) Altered mental status b) Cold, clammy skin and extremities c) Oliguria with urine output less than 30 ml/h d) Serum-lactate more than 2.0 mmol/l VI) Informed consent

Exclusion Criteria:

  • Resuscitation more than 30 minutes
  • No intrinsic heart action
  • Cerebral deficit with fixed dilated pupils (not drug-induced)
  • Need for primary urgent bypass surgery (to be determined after diagnostic angiography)
  • Single vessel disease
  • Mechanical cause of cardiogenic shock
  • Onset of shock more than 12 h
  • Massive lung emboli
  • Age more than 90 years
  • Shock of other cause (bradycardia, sepsis, hypovolemia, etc.)
  • Other severe concomitant disease with limited life expectancy <6 months
  • Pregnancy
  • Known severe renal insufficiency (creatinine clearance <30 ml/kg)
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01927549


Locations
Germany
University of Goettingen
Goettingen, Germany
Heart Center Leipzig - University Hospital
Leipzig, Germany, 04289
University of Leipzig - Heart Center
Leipzig, Germany, 04289
Sponsors and Collaborators
University of Luebeck
European Commission
German Cardiac Society
Deutsche Stiftung für Herzforschung
Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)
Investigators
Study Chair: Holger Thiele, MD Heartcenter Leipzig GmbH
  More Information

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Holger Thiele, Coordinator, Heartcenter Leipzig GmbH
ClinicalTrials.gov Identifier: NCT01927549     History of Changes
Other Study ID Numbers: CULPRIT-SHOCK1.2
First Submitted: August 14, 2013
First Posted: August 22, 2013
Last Update Posted: November 9, 2017
Last Verified: November 2017

Keywords provided by Holger Thiele, Heartcenter Leipzig GmbH:
cardiogenic shock
infarction
multivessel coronary artery disease
angioplasty

Additional relevant MeSH terms:
Infarction
Myocardial Infarction
Shock
Shock, Cardiogenic
Ischemia
Pathologic Processes
Necrosis
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases