Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Can J Cardiol. 2024 Apr;40(4):664-673. doi: 10.1016/j.cjca.2023.12.005. Epub 2023 Dec 12.
Hemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs).
We included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay.
A total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs.
Among patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.
针对心源性休克（CS）表型的血流动力学评估使肺动脉导管（PAC）的使用重新受到关注。
我们纳入了 2014 年 1 月至 2020 年 12 月因 CS 入院的患者，并比较了接受 PAC 和未接受 PAC 的患者的临床结局。主要结局是院内死亡率。次要结局包括使用高级心力衰竭治疗以及重症监护心脏病房（CICU）和住院时间。
共分析了 1043 例患者，其中 47%接受了 PAC。选择接受 PAC 指导管理的患者年龄较小，左心室功能较低。他们也更常使用血管加压药和正性肌力药，其中 15.2%的患者已经接受了临时机械循环支持（MCS）。接受 PAC 的患者院内死亡率较低（29.3%比 36.2%；P=0.02），主要是由于 SCAI 心源性休克 D 和 E 期患者的死亡率降低。接受 PAC 的患者更可能接受 Impella 临时 MCS、耐用性心室辅助装置（VAD）或原位心脏移植（OHT）（所有分析均 P<0.001）。使用 PAC 的患者 CICU 和住院时间更长。
在心源性休克患者中，PAC 的使用与较低的院内死亡率相关，尤其是在 SCAI 心源性休克 D 和 E 期患者中。接受 PAC 的患者也更常通过临时 MCS 或接受高级心力衰竭治疗（如耐用性 VAD 或 OHT）进行抢救。
