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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Pulmonary Artery Catheter Usage and Impact on Mortality in Patients With Cardiogenic Shock: Results From a Canadian
Ana Beatriz B A C Réa1, Vesna Mihajlovic1, Julie K K Vishram-Nielsen2
1Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Pulmonary artery catheters (PACs) use in cardiogenic shock (CS) patients was linked to reduced in-hospital mortality, particularly in severe cases (SCAI stages D and E). PACs also increased use of mechanical support and advanced heart failure therapies.
Area of Science:
- Cardiology
- Critical Care Medicine
- Hemodynamics
Background:
- Renewed interest in pulmonary artery catheters (PACs) for hemodynamic assessment in cardiogenic shock (CS).
- CS phenotyping requires accurate hemodynamic monitoring.
Purpose of the Study:
- To compare clinical outcomes in CS patients who received PAC-guided management versus those who did not.
- To evaluate the impact of PAC use on in-hospital mortality and advanced therapy utilization.
Main Methods:
- Retrospective analysis of 1043 CS patients admitted between January 2014 and December 2020.
- Comparison of in-hospital mortality, advanced heart failure therapies, and length of stay between PAC and non-PAC groups.
Main Results:
- Patients receiving PACs had lower in-hospital mortality (29.3% vs 36.2%, P=0.02), especially in SCAI stages D and E.
- PAC use was associated with increased utilization of temporary mechanical circulatory support (MCS), durable ventricular assist devices (VADs), and orthotopic heart transplantation (OHT).
- PAC patients were younger with lower left ventricular function, higher vasopressor/inotrope use, and longer hospital stays.
Conclusions:
- PAC use in CS patients is associated with improved survival, particularly in advanced stages.
- PACs facilitate the timely initiation of mechanical circulatory support and advanced heart failure therapies.
Background:
Hemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs).
Methods:
We included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay.
Results:
A total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (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 PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs.
Conclusions:
Among patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.
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