Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

Paul Guedeney; Olivier Barthélémy; Michel Zeitouni; Marie Hauguel-Moreau; Georges Hage; Mathieu Kerneis; Benoit Lattuca; Pavel Overtchouk; Stéphanie Rouanet; Georg Fuernau; Suzanne de Waha-Thiele; Uwe Zeymer; Marcus Sandri; Ibrahim Akin; Steffen Desch; Holger Thiele; Gilles Montalescot

doi:10.1016/j.jcin.2020.04.003

Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

Paul Guedeney, Olivier Barthélémy, Michel Zeitouni, Marie Hauguel-Moreau, Georges Hage, Mathieu Kerneis, Benoit Lattuca, Pavel Overtchouk, Stéphanie Rouanet, Georg Fuernau, Suzanne de Waha-Thiele, Uwe Zeymer, Marcus Sandri, Ibrahim Akin, Steffen Desch, Holger Thiele, Gilles Montalescot^*

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

2 Citations (Scopus)

Abstract

Objectives: This study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS). Background: The prognostic value of the SYNTAX score in this high-risk setting remains unclear. Methods: The CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression. Results: Pre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes. Conclusions: In patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.

Original language	English
Journal	JACC: Cardiovascular Interventions
Volume	13
Issue number	10
Pages (from-to)	1198-1206
Number of pages	9
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2020.04.003
Publication status	Published - 25.05.2020

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10.1016/j.jcin.2020.04.003

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Guedeney, P., Barthélémy, O., Zeitouni, M., Hauguel-Moreau, M., Hage, G., Kerneis, M., Lattuca, B., Overtchouk, P., Rouanet, S., Fuernau, G., de Waha-Thiele, S., Zeymer, U., Sandri, M., Akin, I., Desch, S., Thiele, H., & Montalescot, G. (2020). Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial. JACC: Cardiovascular Interventions, 13(10), 1198-1206. https://doi.org/10.1016/j.jcin.2020.04.003

@article{ce4a7f9a31d9400394de98c42808423d,

title = "Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial",

abstract = "Objectives: This study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS). Background: The prognostic value of the SYNTAX score in this high-risk setting remains unclear. Methods: The CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression. Results: Pre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes. Conclusions: In patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.",

author = "Paul Guedeney and Olivier Barth{\'e}l{\'e}my and Michel Zeitouni and Marie Hauguel-Moreau and Georges Hage and Mathieu Kerneis and Benoit Lattuca and Pavel Overtchouk and St{\'e}phanie Rouanet and Georg Fuernau and {de Waha-Thiele}, Suzanne and Uwe Zeymer and Marcus Sandri and Ibrahim Akin and Steffen Desch and Holger Thiele and Gilles Montalescot",

note = "Funding Information: The CULPRIT-SHOCK trial was supported by European Union Seventh Framework Program grant agreement 602202, the German Heart Research Foundation, and the German Cardiac Society. Dr. Zeitouni has received research grants from Federation Fran?aise de Cardiologie, Institut Servier, and Bristol-Myers Squibb. Dr. Kerneis has received research grants from Sanofi, Institut Servier, and F?d?ration Fran?aise de Cardiologie; and has received consulting fees from Bayer, AstraZeneca, Servier, and Sanofi. Dr. Lattuca has received research grants from Biotronik, Daiichi-Sankyo, Medtronic, and F?d?ration Fran?aise de Cardiologie; consulting fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. Dr. Zeymer has received personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Sanofi, MSD, The Medicines Company, Pfizer, Daiichi-Sankyo, Eli Lilly, and Abiomed, outside the submitted work. Dr. Montalescot has received institutional research grants or consulting/lecture fees in the past 2 years from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham and Women's Hospital, the Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli Lilly, Europa, Elsevier, F?d?ration Fran?aise de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, Institute of Cardiometabolism And Nutrition, Janssen, Lead-Up, Menarini, Medtronic, MSD, Pfizer, Sanofi, The Medicines Company, TIMI Study Group, and WebMD. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = may,

day = "25",

doi = "10.1016/j.jcin.2020.04.003",

language = "English",

volume = "13",

pages = "1198--1206",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

number = "10",

}

Guedeney, P, Barthélémy, O, Zeitouni, M, Hauguel-Moreau, M, Hage, G, Kerneis, M, Lattuca, B, Overtchouk, P, Rouanet, S, Fuernau, G , de Waha-Thiele, S, Zeymer, U, Sandri, M, Akin, I, Desch, S, Thiele, H & Montalescot, G 2020, 'Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial', JACC: Cardiovascular Interventions, vol. 13, no. 10, pp. 1198-1206. https://doi.org/10.1016/j.jcin.2020.04.003

TY - JOUR

T1 - Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

AU - Guedeney, Paul

AU - Barthélémy, Olivier

AU - Zeitouni, Michel

AU - Hauguel-Moreau, Marie

AU - Hage, Georges

AU - Kerneis, Mathieu

AU - Lattuca, Benoit

AU - Overtchouk, Pavel

AU - Rouanet, Stéphanie

AU - Fuernau, Georg

AU - de Waha-Thiele, Suzanne

AU - Zeymer, Uwe

AU - Sandri, Marcus

AU - Akin, Ibrahim

AU - Desch, Steffen

AU - Thiele, Holger

AU - Montalescot, Gilles

N1 - Funding Information: The CULPRIT-SHOCK trial was supported by European Union Seventh Framework Program grant agreement 602202, the German Heart Research Foundation, and the German Cardiac Society. Dr. Zeitouni has received research grants from Federation Fran?aise de Cardiologie, Institut Servier, and Bristol-Myers Squibb. Dr. Kerneis has received research grants from Sanofi, Institut Servier, and F?d?ration Fran?aise de Cardiologie; and has received consulting fees from Bayer, AstraZeneca, Servier, and Sanofi. Dr. Lattuca has received research grants from Biotronik, Daiichi-Sankyo, Medtronic, and F?d?ration Fran?aise de Cardiologie; consulting fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. Dr. Zeymer has received personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Sanofi, MSD, The Medicines Company, Pfizer, Daiichi-Sankyo, Eli Lilly, and Abiomed, outside the submitted work. Dr. Montalescot has received institutional research grants or consulting/lecture fees in the past 2 years from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham and Women's Hospital, the Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli Lilly, Europa, Elsevier, F?d?ration Fran?aise de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, Institute of Cardiometabolism And Nutrition, Janssen, Lead-Up, Menarini, Medtronic, MSD, Pfizer, Sanofi, The Medicines Company, TIMI Study Group, and WebMD. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2020 American College of Cardiology Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/5/25

Y1 - 2020/5/25

N2 - Objectives: This study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS). Background: The prognostic value of the SYNTAX score in this high-risk setting remains unclear. Methods: The CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression. Results: Pre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes. Conclusions: In patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.

AB - Objectives: This study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS). Background: The prognostic value of the SYNTAX score in this high-risk setting remains unclear. Methods: The CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression. Results: Pre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes. Conclusions: In patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.

UR - http://www.scopus.com/inward/record.url?scp=85084375367&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2020.04.003

DO - 10.1016/j.jcin.2020.04.003

M3 - Journal articles

C2 - 32438990

AN - SCOPUS:85084375367

SN - 1936-8798

VL - 13

SP - 1198

EP - 1206

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 10

ER -

Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

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