Can J Cardiol. 2023 Dec 11:S0828-282X(23)01976-1. doi: 10.1016/j.cjca.2023.12.005. Online ahead of print.
ABSTRACT
BACKGROUND: Hemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PAC).
METHODS: We included patients admitted with CS from January 2014-December 2020 and compared clinical outcomes among patients who received PAC and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included utilization of advanced heart failure therapies, coronary intensive care units (CICU) and hospital length-of-stay.
RESULTS: 1,043 patients were analyzed and 47% received PAC. Patients selected for PAC-guided management were younger, had a lower left ventricular function. They also had higher use of vasopressor and/or inotropes and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PAC (29.3% vs. 36.2%; p = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PAC were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VAD), and orthotopic heart transplantation (OHT) (p < 0.001 for all analysis). CICU and hospital length-of-stay were longer in patients who used PAC.
CONCLUSIONS: Among patients with CS, the use of PAC was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PAC were also more frequently rescued with temporary MCS or received advanced heart failure therapies such as durable VAD or OHT.
PMID:38092192 | DOI:10.1016/j.cjca.2023.12.005