Complex PCI: Nothing Is Simple in Shock Patients!-CTO’s in AMI-Shock: When and How to Treat, Dr. Rhian E. Davies

Video Transcription

Video Summary

The presentation addresses management of chronic total occlusions (CTOs) in acute myocardial infarction (AMI) complicated by cardiogenic shock. About 40-50% of AMI shock patients have concomitant CTOs, which worsen outcomes due to compromised collateral circulation and reduced left ventricular function. Current guidelines and key trials recommend culprit-only percutaneous coronary intervention (PCI) during the acute phase, as multi-vessel PCI, particularly involving CTOs, may increase complications without clear survival benefits. Staged CTO PCI is favored once patients stabilize, especially for large viable myocardial territories like LAD CTOs, and ideally performed by experienced operators with careful contrast use. Two clinical cases illustrated successful staged CTO interventions after stabilization. Panel discussions emphasized individualized access strategies, favoring radial access when feasible, and cautious use of emerging tools like drug-coated balloons, currently limited to in-stent restenosis. Overall, optimizing culprit lesion treatment in acute shock with selective staged CTO PCI post-stabilization balances procedural risks and improves long-term outcomes, although further studies are needed.

Keywords

chronic total occlusions

acute myocardial infarction

cardiogenic shock

percutaneous coronary intervention

staged CTO PCI