Effect of pulmonary artery catheters in patients with cardiovascular diseases stratified based on severity: a propensity score-matched analysis.

PURPOSE

This study aimed to assess the effect of pulmonary artery catheter (PAC) use on clinical outcomes in cardiovascular patients stratified by severity using the Acute Physiology and Chronic Health Evaluation (APACHE) III score.

METHODS

This study was conducted at Hamamatsu University Hospital and included intensive care unit (ICU) patients with cardiovascular diseases from April 2019 to March 2024. Patients were stratified into overall, severe, and critically severe cohorts based on their APACHE III scores. PAC group included those with PAC use within 24 h of ICU admission, while non-users formed the control group. The primary outcome was in-hospital mortality, whereas the secondary outcomes included ICU mortality, initiation of renal replacement therapy, mechanical circulatory support-free days at day 28, and lengths of hospital and ICU stay. One-to-one propensity score matching was performed to adjust for baseline differences.

RESULTS

Of the 1,693 patients, matched pairs were created for 210, 136, and 62 in the overall, severe, and critically severe cohorts, respectively. In-hospital mortality did not differ significantly between PAC and control groups across all cohorts (overall: 8.6% vs. 10.0%, p = 0.61; severe: 14.0% vs. 14.0%, p > 0.99; critically severe: 22.6% vs. 25.8%, p = 0.68). Among secondary outcomes, PAC use was significantly associated with increased renal replacement therapy and prolonged ICU stays in the overall and critically severe cohorts.

CONCLUSIONS

PAC use was not associated with improved outcomes in critically ill patients with cardiovascular diseases, even among those with a high mortality risk, suggesting the need for further studies.