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Multicenter Study
. 2020 Nov;8(11):903-913.
doi: 10.1016/j.jchf.2020.08.012.

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

A Reshad Garan  1 , Manreet Kanwar  2 , Katherine L Thayer  3 , Evan Whitehead  4 , Elric Zweck  5 , Jaime Hernandez-Montfort  6 , Claudius Mahr  7 , Jillian L Haywood  3 , Neil M Harwani  3 , Detlef Wencker  8 , Shashank S Sinha  9 , Esther Vorovich  10 , Jacob Abraham  11 , William O'Neill  12 , Daniel Burkhoff  13 , Navin K Kapur  14
Affiliations
Free article
Multicenter Study

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

A Reshad Garan et al. JACC Heart Fail. 2020 Nov.
Free article

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.

Keywords: cardiogenic shock; hemodynamics; mechanical circulatory support; pulmonary artery catheter.

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Conflict of interest statement

Author Relationship With Industry Funding was received from the Cardiogenic Shock Working Group Fund, Abbott, Abiomed, and Boston Scientific. The Cardiogenic Shock Working Group had full control over the content of the manuscript and none of the industry sponsors had a role in the final presentation of this work. Dr. Garan has served as an unpaid advisor to Abiomed; and received research support from Abbott. Dr. Kanwar is an advisor to Abiomed. Dr. Mahr is a consultant for Abbott, Medtronic, and Abiomed. Dr. O’Neill is a consultant for Abiomed and Abbott. Dr. Kapur has received speaker/consulting honoraria from Abbott, Abiomed, Boston Scientific, Medtronic, MDStart, LivaNova, Getinge; and has received Institutional Research Grants from Abbott, Abiomed, Boston Scientific and MDStart.

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