Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania.
JACC Heart Fail. 2020 Nov;8(11):903-913. doi: 10.1016/j.jchf.2020.08.012.
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).
Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking.
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).
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).
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.
本研究旨在探讨早期肺动脉导管（PAC）置管获取血流动力学数据与心源性休克（CS）结局之间的关系。
尽管 PAC 被用于指导 CS 管理决策，但缺乏支持其在 CS 中最佳应用的证据。
CSWG 从 2016 年至 2019 年在 8 家三级护理机构中收集 CS 患者的回顾性数据。根据血管造影和介入学会（SCAI）分期，将患者分为两组，并在开始机械循环支持（MCS）之前分析 PAC 使用组（无 PAC 数据、不完全 PAC 数据、完全 PAC 数据）的结果。
在分析的 1414 例 CS 患者中，1025 例（72.5%）为男性，494 例（34.9%）为心肌梗死患者；758 例（53.6%）为 SCAI 级 D 休克，263 例（18.6%）为 SCAI 级 C 休克。在晚期 CS 阶段，有 1190 例（84%）患者使用了临时 MCS 设备。在开始 MCS 之前，有 216 例（18%）患者未获得 PAC 数据，而 598 例（42%）患者有完整的血流动力学数据。在整个队列中，PAC 使用组之间的死亡率存在显著差异（p<0.001），并且在每个 SCAI 分期亚组中也是如此（SCAI 级 C：p=0.03；SCAI 级 D：p=0.05；SCAI 级 E：p=0.02）。在所有 SCAI 分期中，完整 PAC 评估组的住院死亡率均低于其他组。在整个队列中，与完整 PAC 评估相比，无 PAC 评估与更高的住院死亡率相关（调整后的优势比：1.57；95%置信区间：1.06 至 2.33）。
CSWG 是一个大型多中心注册中心，代表了当代 MCS 时代真实世界的 CS 患者。在开始 MCS 之前使用完整的 PAC 衍生血流动力学数据与 CS 生存率的提高相关。
