Cardiology Department, Intensive Cardiac Care Unit, 16689Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain.
INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, Paris, France.
J Intensive Care Med. 2020 Dec;35(12):1426-1433. doi: 10.1177/0885066619828959. Epub 2019 Feb 7.
Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC).
Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes.
Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices ( < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score.
In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.
心原性休克（CS）是急性心力衰竭最具生命威胁的表现。其复杂性和高院内死亡率可能证明需要使用肺动脉导管（PAC）进行有创监测。
对纳入 CardShock 研究的 CS 患者进行分析，该研究是一项观察性、前瞻性、多中心、欧洲注册研究，旨在描述 PAC 的实际应用，评估其对 30 天死亡率的影响，以及不同血流动力学参数预测结局的能力。
在 219 例患者中，82 例（37.4%）使用了肺动脉导管。使用 PAC 的 CS 患者更频繁地接受正性肌力药和血管加压药、机械通气、肾脏替代治疗和机械辅助装置的治疗（<0.01）。总体 30 天死亡率为 36.5%。即使在倾向评分匹配分析后，PAC 使用也未影响死亡率（危险比=1.17[0.59-2.32]，=0.66）。心脏指数、心功率指数（CPI）和每搏输出量指数（SVI）在预测 30 天死亡率方面具有最高的曲线下面积（范围为 0.752-0.803），并允许显著的净重新分类改善 0.467（0.083-1.180）、0.700（0.185-1.282）、0.683（0.168-1.141），当添加到 CardShock 风险评分时。
在我们当代 CS 队列中，超过三分之一的患者接受了 PAC 治疗。PAC 使用与更积极的治疗策略相关。然而，PAC 使用与 30 天死亡率无关。心脏指数、CPI 和 SVI 是除之前验证的 CardShock 风险评分外预测 30 天死亡率的最强指标。
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