JACC: Heart Failure ( IF 10.3 ) Pub Date : 2020-10-26 , DOI: 10.1016/j.jchf.2020.08.012 A Reshad Garan 1 , Manreet Kanwar 2 , Katherine L Thayer 3 , Evan Whitehead 4 , Elric Zweck 5 , Jaime Hernandez-Montfort 6 , Claudius Mahr 7 , Jillian L Haywood 3 , Neil M Harwani 3 , Detlef Wencker 8 , Shashank S Sinha 9 , Esther Vorovich 10 , Jacob Abraham 11 , William O'Neill 12 , Daniel Burkhoff 13 , Navin K Kapur 3
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Objectives
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).
Background
Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking.
Methods
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).
Results
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).
Conclusions
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.
中文翻译：
在心源性休克中使用肺动脉导管进行完整的血流动力学分析与较低的院内死亡率相关
目标
本研究的目的是调查从早期肺动脉导管 (PAC) 放置获得的血流动力学数据与心源性休克 (CS) 结局之间的关联。
背景
尽管 PAC 用于指导 CS 管理决策，但缺乏支持其在 CS 中最佳使用的证据。
方法
心源性休克工作组 (CSWG) 收集了 2016 年至 2019 年 8 家三级医疗机构的 CS 患者的回顾性数据。 患者按心血管血管造影和干预协会 (SCAI) 分期和 PAC 使用组（无 PAC数据、不完整的 PAC 数据、完整的 PAC 数据），然后再启动机械循环支持 (MCS)。
结果
在分析的 1,414 名 CS 患者中，1,025 名 (72.5%) 为男性，494 名 (34.9%) 出现心肌梗塞；758 人（53.6%）处于 SCAI D 期休克，263 人（18.6%）处于 C 期休克。1,190 (84%) 名处于高级 CS 阶段的患者使用了临时 MCS 设备。在 MCS 之前，216 名患者 (18%) 未获得 PAC 数据，而 598 名患者 (42%) 具有完整的血流动力学数据。整个队列中 PAC 使用组（p < 0.001）和每个 SCAI 阶段子队列（阶段 C：p = 0.03；阶段 D：p = 0.05；阶段 E：p = 0.02）的死亡率显着不同。在所有 SCAI 阶段，完整 PAC 评估组的院内死亡率低于其他组。在整个队列中，与完全 PAC 评估相比，未进行 PAC 评估与更高的院内死亡率相关（调整后的优势比：1.57；
结论
CSWG 是一个大型多中心注册中心，代表当代 MCS 时代真实世界的 CS 患者。在 MCS 开始之前使用完整的 PAC 衍生的血流动力学数据与提高 CS 的存活率相关。
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