Pulmonary Artery Catheter Use and Risk of In-Hospital Death in Heart Failure Cardiogenic Shock

Document Type

Article

Publication Date

5-13-2023

Institution/Department

Cardiology

Journal Title

Journal of cardiac failure

Abstract

BACKGROUND: Pulmonary artery catheters (PACs) are increasingly used to guide management decisions in cardiogenic shock (CS). OBJECTIVES: The goal of this study was to determine if PAC use was associated with a lower risk of in-hospital mortality in CS due to acute heart failure (HF-CS). METHODS: Multicenter, retrospective, observational study of CS patients hospitalized between 2019-2021 at 15 US hospitals participating in the Cardiogenic Shock Working Group registry. The primary endpoint was in-hospital mortality. Inverse probability of treatment-weighted logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CI), accounting for multiple variables at admission. The association between timing of PAC placement and in-hospital death was also analyzed. RESULTS: A total of 1055 HF-CS patients were included of whom 834 (79%) received a PAC during their hospitalization. In-hospital mortality risk for the cohort was 24.7% (n=261). PAC use was associated with lower adjusted in-hospital mortality risk (22.2% vs. 29.8%, OR 0.68, 95% CI 0.50-0.94). Similar associations were found across SCAI stages of shock, both at admission and at maximum SCAI stage during hospitalization. Early PAC use (≤ 6 hours of admission) was observed in 220 (26%) PAC recipients and associated with a lower adjusted risk of in-hospital mortality compared to delayed (≥ 48 hours) or no PAC use (17.3% vs. 27.7%, OR 0.54, 95% CI 0.37-0.81). CONCLUSIONS: This observational study supports PAC use, as it was associated with decreased in-hospital mortality in HF-CS, especially if performed within 6 hours of hospital admission. CONDENSED ABSTRACT: An observational study from the Cardiogenic Shock Working Group registry of 1,055 patients with heart failure related cardiogenic shock showed that pulmonary artery catheter (PAC) use was associated with lower adjusted in-hospital mortality risk (22.2% vs. 29.8%, OR 0.68, 95% CI 0.50-0.94) compared to outcomes in patients managed without PAC. Early PAC use (≤ 6 hours of admission) was associated with a lower adjusted risk of in-hospital mortality compared to delayed (≥ 48 hours) or no PAC use (17.3% vs. 27.7%, OR 0.54, 95% CI 0.37-0.81).

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