{
  "abstract": "Objectives To compare in-hospital and long-term outcomes between culprit-only percutaneous coronary intervention (PCI) and multivessel PCI in patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease.Design Retrospective subgroup analysis of the multicentre Gulf-Cardiogenic Shock registry.Setting 13 tertiary care centres across six Gulf countries (Saudi Arabia, Qatar, Oman, UAE, Kuwait and Bahrain) between January 2020 and December 2022.Participants 961 patients with angiographically confirmed multivessel coronary artery disease who underwent PCI were included from the Gulf-Cardiogenic Shock registry. Patients were divided into culprit-only PCI group (n=792, 82.4%) and multivessel PCI group (n=169, 17.6%). Patients with single-vessel disease were excluded.Interventions Patients underwent either culprit-only PCI (intervention limited to the culprit artery) or multivessel PCI (immediate intervention to both culprit and non-culprit arteries during the same procedure).Primary and secondary outcome measures The primary outcome was in-hospital all-cause mortality. Secondary outcomes included reinfarction, cerebrovascular accident, major and minor bleeding events, target lesion revascularisation, target vessel revascularisation, hospital stay duration and freedom from major adverse cardiac and cerebrovascular events (MACCEs) at 6 and 12 months.Results Hospital mortality was comparable between multivessel PCI and culprit-only PCI groups (43.2% vs 46.1%; p=0.493). Freedom from MACCE rates at 6 and 12 months were 62% and 46% for multivessel PCI versus 70% and 49% for culprit-only PCI, respectively (log-rank p=0.711). Subgroup analysis revealed that culprit-only PCI was associated with increased hospital mortality in patients older than 70 years (OR 1.55, 95% CI: 1.01 to 2.39). Multivariable analysis of the interaction between revascularisation strategy and the subgroups revealed that culprit vessel revascularisation was associated with increased mortality in patients with left main disease (OR: 1.99 (95% CI: 1.22 to 3.27), p=0.006) and left anterior descending lesions (OR: 1.54 (95% CI: 1.06 to 2.25), p=0.025).Conclusions No statistically significant differences in hospital mortality or long-term MACCE-free survival were observed between culprit-only PCI and multivessel PCI strategies in patients with cardiogenic shock complicating acute myocardial infarction. However, patients older than 70 years may benefit from a multivessel PCI approach. These findings support current guideline recommendations favouring culprit-only PCI due to reduced procedural complexity while highlighting the need for individualised treatment strategies based on patient age and clinical factors. Further prospective randomised studies are needed to validate these age-specific findings and identify optimal patient selection criteria for each revascularisation strategy.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia"
      ],
      "name": "Amin Daoulah"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA"
      ],
      "name": "Shaber Seraj"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia",
        "Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt"
      ],
      "name": "Ahmed Elmahrouk"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt",
        "Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia",
        "Health Research Center, Ministry Of Defense Health Services, Riyadh, Saudi Arabia"
      ],
      "name": "Amr A Arafat"
    },
    {
      "affiliations": [
        "Department of Cardiology, The Royal Hospital National Heart Center, Muscat, Oman"
      ],
      "name": "Prashanth Panduranga"
    },
    {
      "affiliations": [
        "Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE"
      ],
      "name": "Wael Almahmeed"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hamad Medical Corporation, Doha, Qatar"
      ],
      "name": "Abdulrahman Arabi"
    },
    {
      "affiliations": [
        "Department of Anesthesia, King Abdulaziz Medical City in Riyadh, Riyadh, Saudi Arabia"
      ],
      "name": "Sultan Alobaikan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Armed Forces Hospitals Southern Region, Khamis Mushait, Saudi Arabia"
      ],
      "name": "Mohammed Al Shehri"
    },
    {
      "affiliations": [
        "Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain"
      ],
      "name": "Nooraldaem Yousif"
    },
    {
      "affiliations": [
        "King Saud Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Hatem Aloui"
    },
    {
      "affiliations": [
        "Department Of Medicine, Cardiac Center Of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Mohammed Qutub"
    },
    {
      "affiliations": [
        "King Saud University, Riyadh, Saudi Arabia"
      ],
      "name": "Waleed Alharbi"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sabah Al Ahmad Cardiac Center, Amiri Hospital, Kuwait City, Kuwait"
      ],
      "name": "Rajesh Rajan"
    },
    {
      "affiliations": [
        "Department of Cardiology, International Medical Center, Jeddah, Saudi Arabia"
      ],
      "name": "Mokhtar Kahin"
    },
    {
      "affiliations": [
        "Sultan Qaboos University Hospital, Seeb, Oman"
      ],
      "name": "Said Al Maashani"
    },
    {
      "affiliations": [
        "Bugshan Hospital, Jeddah, Saudi Arabia"
      ],
      "name": "Taher Hassan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hamad Medical Corporation, Doha, Qatar"
      ],
      "name": "Jassim Al Suwaidi"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hamad Medical Corporation, Doha, Qatar"
      ],
      "name": "Awad Abdulrazaq AlQahtani"
    },
    {
      "affiliations": [
        "King Saud Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Mubarak Abdulhadi Aldossari"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sabah Al Ahmad Cardiac Center, Amiri Hospital, Kuwait City, Kuwait"
      ],
      "name": "Mohammed Al-Jarallah"
    },
    {
      "affiliations": [
        "King Khalid University, Abha, Saudi Arabia"
      ],
      "name": "Ali Alshehri"
    },
    {
      "affiliations": [
        "Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia",
        "Department of Cardiology, Faculty of Medicine Al-Azhar University, Cairo, Egypt"
      ],
      "name": "Abdelmaksoud Elganady"
    },
    {
      "affiliations": [
        "Department Of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia"
      ],
      "name": "Badr Alzahrani"
    },
    {
      "affiliations": [
        "King Fahad Medical City, Riyadh, Saudi Arabia",
        "College Of Medicine, Alfaisal University, Riyadh, Saudi Arabia"
      ],
      "name": "Alaa Aldossari"
    },
    {
      "affiliations": [
        "King Fahad Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Abdulrahman M Alqahtani"
    },
    {
      "affiliations": [
        "Madinah Cardiac Center, Medina, Saudi Arabia"
      ],
      "name": "Faisal Al Nasser"
    },
    {
      "affiliations": [
        "Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain"
      ],
      "name": "Haitham Amin"
    },
    {
      "affiliations": [
        "Department Of Medicine, Cardiac Center Of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Mohamed N Alama"
    },
    {
      "affiliations": [
        "Department of Cardiology, Faculty of Medicine Al-Azhar University, Cairo, Egypt"
      ],
      "name": "Alsayed Ali Almarghany"
    },
    {
      "affiliations": [
        "Chest Diseases Hospital, Kuwait City, Kuwait"
      ],
      "name": "Abdullah Alenezi"
    },
    {
      "affiliations": [
        "Chest Diseases Hospital, Kuwait City, Kuwait"
      ],
      "name": "Khaled Almerri"
    },
    {
      "affiliations": [
        "Elrazi University, Khartoum, Sudan"
      ],
      "name": "Omar Kanbr"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia"
      ],
      "name": "Ahmed Jamjoom"
    },
    {
      "affiliations": [
        "Tanta University, Tanta, Egypt"
      ],
      "name": "Youssef Elmahrouk"
    },
    {
      "affiliations": [
        "King Abdulaziz Specialist Hospital, Aljawf, Saudi Arabia"
      ],
      "name": "Ibrahim A M Abdulhabeeb"
    },
    {
      "affiliations": [
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"
      ],
      "name": "Mohammed Ali Balghith"
    },
    {
      "affiliations": [
        "King Saud University, Riyadh, Saudi Arabia"
      ],
      "name": "Ahmad Hersi"
    },
    {
      "affiliations": [
        "Department of Cardiology, The Royal Hospital National Heart Center, Muscat, Oman"
      ],
      "name": "Abeer Said Mohamed Al Rawahi"
    },
    {
      "affiliations": [
        "Department of Cardiology, The Royal Hospital National Heart Center, Muscat, Oman"
      ],
      "name": "Marwa Abd Elghany Albasiouny Alkholy"
    },
    {
      "affiliations": [
        "Department of Cardiology, King's College Hospital London, Jeddah, Saudi Arabia"
      ],
      "name": "Adnan Hussien"
    },
    {
      "affiliations": [
        "Department Of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia"
      ],
      "name": "Abdulrahman Almoghairi"
    },
    {
      "affiliations": [
        "Department Of Medicine, Cardiac Center Of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Mohamed Mohammednabil A Alama"
    },
    {
      "affiliations": [
        "Madinah Cardiac Center, Medina, Saudi Arabia"
      ],
      "name": "Mohamed Ajaz Ghani"
    },
    {
      "affiliations": [
        "King Saud Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Ayman Al Hussini"
    },
    {
      "affiliations": [
        "King Saud University, Riyadh, Saudi Arabia"
      ],
      "name": "Ayman Basardah"
    },
    {
      "affiliations": [
        "Department Of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia"
      ],
      "name": "Bandar Alshehri"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sabah Al Ahmad Cardiac Center, Amiri Hospital, Kuwait City, Kuwait",
        "Royal College Of Surgeons, Royal College of Surgeons, Dublin, Irland"
      ],
      "name": "Laura Al Obaid"
    },
    {
      "affiliations": [
        "Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Khalid Alshali"
    },
    {
      "affiliations": [
        "King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Sara Shawki Saati"
    },
    {
      "affiliations": [
        "Department of Cardiology, King's College Hospital London, Jeddah, Saudi Arabia"
      ],
      "name": "Seraj Abualnaja"
    },
    {
      "affiliations": [
        "Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain"
      ],
      "name": "Tarique Shahzad Chachar"
    },
    {
      "affiliations": [
        "Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE"
      ],
      "name": "Hassan Khan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Brompton Hospital, London, UK"
      ],
      "name": "Shahrukh Hashmani"
    },
    {
      "affiliations": [
        "Department Of Medicine, Cardiac Center Of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Ahmed A Ghonim"
    },
    {
      "affiliations": [
        "King Fahad Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Razan waleed W Alsofayan"
    },
    {
      "affiliations": [
        "Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia",
        "Department of Cardiology, Faculty of Medicine Al-Azhar University, Cairo, Egypt"
      ],
      "name": "Abeer M Shawky"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA"
      ],
      "name": "Amir Lotfi"
    }
  ],
  "title": "Comparative outcomes of culprit-only versus complete revascularisation in cardiogenic shock complicating acute myocardial infarction: insights from the Gulf-Cardiogenic Shock registry",
  "uid": "d5e218d5-2f28-5e6b-887a-88a65fe9743a"
}