Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality

A. Reshad Garan, Manreet Kanwar, Katherine L. Thayer, Evan Whitehead, Elric Zweck, Jaime Hernandez-Montfort, Claudius Mahr, Jillian L. Haywood, Neil M. Harwani, Detlef Wencker, Shashank S. Sinha, Esther Vorovich, Jacob Abraham, William O'Neill, Daniel Burkhoff, Navin K. Kapur*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: The purpose of this study was to investigate the association between obtaining hemodynamic data from early pulmonary artery catheter (PAC) placement and outcomes in cardiogenic shock (CS). Background: Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking. Methods: The Cardiogenic Shock Working Group (CSWG) collected retrospective data in CS patients from 8 tertiary care institutions from 2016 to 2019. Patients were divided by Society for Cardiovascular Angiography and Interventions (SCAI) stages and outcomes analyzed by the PAC-use group (no PAC data, incomplete PAC data, complete PAC data) prior to initiating mechanical circulatory support (MCS). Results: Of 1,414 patients with CS analyzed, 1,025 (72.5%) were male, and 494 (34.9%) presented with myocardial infarction; 758 (53.6%) were in SCAI Stage D shock, and 263 (18.6%) were in Stage C shock. Temporary MCS devices were used in 1,190 (84%) of those in advanced CS stages. PAC data were not obtained in 216 patients (18%) prior to MCS, whereas 598 patients (42%) had complete hemodynamic data. Mortality differed significantly between PAC-use groups within the overall cohort (p < 0.001), and each SCAI Stage subcohort (Stage C: p = 0.03; Stage D: p = 0.05; Stage E: p = 0.02). The complete PAC assessment group had the lowest in-hospital mortality than the other groups across all SCAI stages. Having no PAC assessment was associated with higher in-hospital mortality than complete PAC assessment in the overall cohort (adjusted odds ratio: 1.57; 95% confidence interval: 1.06 to 2.33). Conclusions: The CSWG is a large multicenter registry representing real-world patients with CS in the contemporary MCS era. Use of complete PAC-derived hemodynamic data prior to MCS initiation is associated with improved survival from CS.

Original languageEnglish (US)
Pages (from-to)903-913
Number of pages11
JournalJACC: Heart Failure
Volume8
Issue number11
DOIs
StatePublished - Nov 2020

Keywords

  • cardiogenic shock
  • hemodynamics
  • mechanical circulatory support
  • pulmonary artery catheter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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