Abstract 16479: The Effects of Pulmonary Artery Catheter Usage and Treatment Intensity on Mortality in Patients With Cardiogenic Shock by Etiology
Wissam Khalife, Aiham Albaeni, Jacob Abraham, Van-Khue Ton, Maya Guglin, Rachna Kataria, Yijing Zhang, BORUI LI, Kevin John, Gavin W Hickey, Jaime Hernandez-Montfort, Shashank Sinha, Paavni Sangal, Neil Harwani, Manreet Kanwar, Arvind Bhimaraj, Daniel Burkhoff, Navin K Kapur- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: The routine usage of pulmonary artery catheter (PAC) in the management of cardiogenic shock (CS) by etiology remains controversial.
Objectives: We sought to study the prognostic effects of PAC usage and the escalation of care in a large CS cohort.
Methods: Multicenter, retrospective, observational study from the Cardiogenic Shock Working Group registry (CSWG) registry. The baseline characteristics, hospital course, and outcome of patients (pts) with acute decompensated heart failure-CS (ADHF) and acute myocardial infarction-CS (AMI) who had PAC during hospitalization were obtained. Different types of interventions were analyzed and compared between survival and non-survival by etiology.
Results: The registry had 3524 pts (58% ADHF, 28% AMI). The overall mortality rate was significantly higher in the AMI group (41 vs 29%, p <0.0001). There was no difference in PAC usage (68 vs 62%). In ADHF, the mortality was significantly lower when PAC was used (22 vs 35%, P<0.0001). However, in AMI, there was no significant mortality difference with PAC usage (40 vs 46%, P=0.052).Pts who had PAC (n=2260, 71% male, 2/3 ADHF) were then analyzed. ADHF had longer duration of PAC (6.3 vs 4.7 days). ADHF pts had more comorbidities (CKD, DM, AF) and better admission and max SCAI stage. However, AMI pts were older (60±14 vs 66±12 year p<0001), more HTN and higher transfer rate. During hospitalization, the effect of treatment intensity with mechanical circulatory support (MCS) and drugs usage on mortality is summarized in fig.1 (a,b).
Conclusions: In a large CS registry, we identified that ADHF is more common with much better prognosis than AMI despite similar PAC and drugs usage, and less MCS usage. This can be explained by the difference in baseline characteristic and the shock severity. PAC usage did correlate with better survival only in ADHF group. Multiple MCS and multiple drugs usage were associated with higher mortality in both groups. IABP, when used alone, had better survival.