Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio.
J Card Fail. 2023 Sep;29(9):1234-1244. doi: 10.1016/j.cardfail.2023.05.001. Epub 2023 May 13.
Pulmonary artery catheters (PACs) are increasingly used to guide management decisions in cardiogenic shock (CS). The goal of this study was to determine if PAC use was associated with a lower risk of in-hospital mortality in CS owing to acute heart failure (HF-CS).
This multicenter, retrospective, observational study included patients with CS hospitalized between 2019 and 2021 at 15 US hospitals participating in the Cardiogenic Shock Working Group registry. The primary end point was in-hospital mortality. Inverse probability of treatment-weighted logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CI), accounting for multiple variables at admission. The association between the timing of PAC placement and in-hospital death was also analyzed. A total of 1055 patients with HF-CS were included, of whom 834 (79%) received a PAC during their hospitalization. In-hospital mortality risk for the cohort was 24.7% (n = 261). PAC use was associated with lower adjusted in-hospital mortality risk (22.2% vs 29.8%, OR 0.68, 95% CI 0.50-0.94). Similar associations were found across SCAI stages of shock, both at admission and at maximum SCAI stage during hospitalization. Early PAC use (≤6 hours of admission) was observed in 220 PAC recipients (26%) and associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, OR 0.54, 95% CI 0.37-0.81).
This observational study supports PAC use, because it was associated with decreased in-hospital mortality in HF-CS, especially if performed within 6 hours of hospital admission.
An observational study from the Cardiogenic Shock Working Group registry of 1055 patients with HF-CS showed that pulmonary artery catheter (PAC) use was associated with a lower adjusted in-hospital mortality risk (22.2% vs 29.8%, odds ratio 0.68, 95% confidence interval 0.50-0.94) compared with outcomes in patients managed without PAC. Early PAC use (≤6 hours of admission) was associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, odds ratio 0.54, 95% confidence interval 0.37-0.81).
肺动脉导管（PAC）越来越多地用于指导心源性休克（CS）的治疗决策。本研究的目的是确定在急性心力衰竭（HF-CS）引起的心源性休克中，PAC 的使用是否与住院死亡率降低有关。
这是一项多中心、回顾性、观察性研究，纳入了 2019 年至 2021 年期间在参与心源性休克工作组注册研究的 15 家美国医院住院的 CS 患者。主要终点是住院死亡率。采用逆概率治疗加权逻辑回归模型来估计比值比（OR）和相应的 95%置信区间（CI），同时考虑入院时的多个变量。还分析了 PAC 放置时间与住院死亡之间的关系。共纳入 1055 例 HF-CS 患者，其中 834 例（79%）在住院期间接受了 PAC。该队列的住院死亡率为 24.7%（n=261）。PAC 使用与调整后住院死亡率降低相关（22.2% vs 29.8%，OR 0.68，95%CI 0.50-0.94）。在休克的 SCAI 各阶段，包括入院时和住院期间的最大 SCAI 阶段，均观察到类似的关联。在 220 名 PAC 使用者中（26%）观察到早期 PAC 使用（入院后≤6 小时），与延迟（≥48 小时）或不使用 PAC 相比，调整后的住院死亡率降低（17.3% vs 27.7%，OR 0.54，95%CI 0.37-0.81）。
这项观察性研究支持 PAC 使用，因为它与 HF-CS 患者的住院死亡率降低有关，尤其是在入院后 6 小时内使用时。
