CULPRIT-SHOCK Trial
Details
CULPRIT-SHOCK randomised patients with acute myocardial infarction, multivessel coronary disease and cardiogenic shock to culprit-lesion-only PCI versus immediate multivessel PCI. It established culprit-only PCI with staged revascularisation after stabilisation as the preferred strategy in AMI-CS. (sources/cardiogenic-shock-nejm-2026, rating: very high)
Key Facts
- 70–80% of AMI-CS patients have multivessel CAD, making the strategy question unavoidable. (sources/cardiogenic-shock-nejm-2026, rating: very high)
- Primary composite (death or renal replacement therapy): 45.9% culprit-only vs 55.4% immediate multivessel PCI — RR 0.83 (95% CI 0.71–0.96; P = 0.01), driven by a mortality reduction. (sources/cardiogenic-shock-nejm-2026, rating: very high)
- Most surviving culprit-only patients underwent staged revascularisation after stabilisation, so the trial tested timing, not whether non-culprit lesions should ever be treated. (sources/cardiogenic-shock-nejm-2026, rating: very high)
- Current preferred strategy: culprit-lesion-only PCI with staged revascularisation once the patient is stabilised; CABG is considered when PCI is not feasible. (sources/cardiogenic-shock-nejm-2026, rating: very high)
- Renal replacement therapy was used in 14% of trial patients. (sources/cardiogenic-shock-nejm-2026, rating: very high)
Contradictions / Open Questions
- The result is about immediate multivessel PCI during shock, not about complete revascularisation as such. Because most culprit-only survivors were staged later, the trial does not argue against treating all lesions — it argues against doing so all at once in an unstable patient. (sources/cardiogenic-shock-nejm-2026, rating: very high)
- The optimal timing of the staged procedure is untested; "after stabilisation" is a clinical judgement, not a protocol tested in the trial.
- The trial predates contemporary shock-team and tMCS practice, so whether the same strategy holds with routine mechanical support is unknown.
Connections
- Related to concepts/Cardiogenic-Shock — AMI-CS management
- Related to concepts/Complete-Revascularization — the contrasting stable-patient strategy; CULPRIT-SHOCK defines the unstable exception
- Related to concepts/Multivessel-PCI-STEMI-Timing — immediate versus staged non-culprit PCI
- Related to entities/Acute-Coronary-Syndrome — the enrolled population