The CULPRIT SHOCK trial: a favourable verdict for the only-culprit percutaneous coronary intervention strategy

Falsifiability is the heart of science, and I could add, falsifiability affects also the science of the heart. In August 2017 the back then new released guidelines of the European Society of Cardiology for management of ST elevated myocardial infarction (STEMI) included as a recommendation class IIa (level C) the percutaneous coronary intervention (PCI) of non-infarct related artery during the index procedure in patients with STEMI, multivessel disease (MVD) presenting with cardiogenic shock (CS) (1). Just few weeks later, this statement was seriously challenged by the CULPRIT-SHOCK trial (2), and one year later, the new European guidelines for myocardial revascularization downgraded the aforementioned recommendation to class III (3).