Revascularization in Cardiogenic Shock: Residual Syntax Score and Chronic Total Occlusions

Abstract

The residual syntax score (rSS) is strongly associated with outcomes in patients with stable coronary artery disease. In patients with acute myocardial infarction-associated cardiogenic shock (AMI-CS), the correlation or association of the rSS, mortality risk, and revascularization strategy has not yet been elucidated and needs more investigation. The SHOCK trial demonstrated that patients with left main and severe triple-vessel disease, who underwent coronary artery bypass grafts, had improved outcomes and higher 1-year survival rates than those with initial medical stabilization. However, it is unclear which is the superior technique for achieving complete revascularization. In contrast to the SHOCK trial’s results, the CULPRIT-MI trial indicated that multivessel intervention had no impact on patient outcomes. Patients with AMI-CS usually have high rSSs due to their complex multivessel disease. Thus, the rSS may be more of a surrogate for the kind of disease than the strategy employed. We, therefore, hypothesize that lowering the rSS might lead to better outcomes. In addition, as there is currently no data confirming an effective targeted strategy, reintroduction of the bypass surgery should be considered.