Shock is associated with high mortality.

Emergency revascularization for CS has improved survival. However, the 35-45% 30-day mortality rate with PCI has persisted for decades despite advances in anti-thrombotic pharmacology and PCI techniques.

Multi-vessel PCI is associated with worse outcomes in MI and cardiogenic shock.

In the CULPRIT-SHOCK study of patients with acute MI, multi-vessel coronary artery disease, and CS, the 30-day risk of a composite of death or severe renal failure was higher among those who underwent multi-vessel PCI in comparison to infarct-artery PCI only. Trials are warranted to test novel strategies that may reduce mortality in patients with MI, multi-vessel CAD, and CS.

Non-randomized data suggest potential benefit from complete revascularization and cardioprotective measures employed with CABG in patients with multi-vessel CAD and CS.

We are in the early stages of planning a randomized trial of initial infarct-only PCI versus multi-vessel CABG with/without IRA reperfusion (mechanical thrombectomy and/or POBA) in patients with MI, multi-vessel CAD, and CS. Your responses to the questions below will help to guide study design.

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