Division of Cardiovascular Medicine, University of Toledo, Toledo, OH.
Department of Hospital Medicine, University of North Dakota, Bismarck, ND.
Curr Probl Cardiol. 2022 Dec;47(12):101388. doi: 10.1016/j.cpcardiol.2022.101388. Epub 2022 Sep 2.
Recent studies showed significant mortality benefit with right heart catheterization (RHC) use in cardiogenic (CS). The optimal timing of RHC in those patients is unknown owing to the lack of available data. The Nationwide Readmission Database 2016-2018 was queried for hospitalizations with CS. We excluded patients presented with cardiac arrest or with a history of ventricular assist devices or heart transplantation. Complex samples multivariable logistic, cox, and linear regression models were used to determine the association between RHC timing in the index admission (<2 days [early RHC] vs ≥ 2 days [late RHC]) and in-hospital outcomes (mortality, acute kidney injury [AKI], mechanical circulatory device use [MCD], index length of stay [LOS], hospital charges), and all-cause 30-day readmissions. A total of 46,963 hospitalizations [18,632 in the early group and 28,332 in the late group] were included in this analysis. RHC was more likely to happen in large teaching hospitals. Although there was no difference in mortality (adjusted odds ratio [aOR]: 1.05; Confidence interval [CI] 0.97-1.14; P= 0.233). Patients in the early RHC group had a lower incidence of AKI (aOR: 0.69; CI: 0.64-0.74; P < 0.01), higher rate of MCS use (aOR:1.67; CI:1.54-1.81; P < 0.001), shorter LOS (aβ :-6.2; CI -6.62 to -5.77; P <.001), lower hospital charges, and lower readmission rates (adjusted hazards ratio [aHR]: 0.91; CI: 0.84- 0.98; P = 0.01) compared to the late RHC group. Early RHC was associated with decreased incidence of AKI, decreased LOS, total charges, and readmission rates with no difference in survival. Subgroup analysis of patients who did not receive MCS during the index admission showed similar outcomes albeit with increased mortality. Further randomized controlled trials are needed to validate these results.
最近的研究表明，在心源性休克（CS）患者中使用右心导管检查（RHC）有显著的生存获益。由于缺乏可用数据，这些患者中 RHC 的最佳时机尚不清楚。2016 年至 2018 年，全国再入院数据库被查询用于 CS 住院治疗。我们排除了出现心搏骤停或有心室辅助装置或心脏移植史的患者。复杂样本多变量逻辑、cox 和线性回归模型用于确定指数入院时（<2 天[早期 RHC]与≥2 天[晚期 RHC]）和住院期间结局（死亡率、急性肾损伤[AKI]、机械循环支持装置使用[MCD]、指数住院时间[LOS]、医院费用）之间的关联，以及全因 30 天再入院。这项分析共纳入 46963 例住院治疗（早期组 18632 例，晚期组 28332 例）。RHC 更可能发生在大型教学医院。尽管死亡率无差异（校正优势比[aOR]：1.05；置信区间[CI]：0.97-1.14；P=0.233）。早期 RHC 组 AKI 发生率较低（aOR：0.69；CI：0.64-0.74；P<0.01），MCS 使用比例较高（aOR：1.67；CI：1.54-1.81；P<0.001），住院时间较短（aβ：-6.2；CI：-6.62 至-5.77；P<0.001），住院费用较低，再入院率较低（调整后的危险比[aHR]：0.91；CI：0.84-0.98；P=0.01）与晚期 RHC 组相比。与晚期 RHC 组相比，早期 RHC 与 AKI 发生率降低、LOS 降低、总费用降低和再入院率降低相关，但生存率无差异。对指数入院期间未接受 MCS 的患者进行亚组分析，结果相似，但死亡率增加。需要进一步的随机对照试验来验证这些结果。
