Abstract 15567: Pulmonary Artery Catheter Use is Associated With Lower Mortality in Cardiogenic Shock, Especially in Heart Failure Related Shock

Abstract

Introduction: Recent analyses have shown an increase in the use of pulmonary artery catheter (PAC), with an associated survival benefit in patients with cardiogenic shock (CS). The impact of PAC use on clinical outcomes among patient with CS due to heart failure (HF-CS) versus acute myocardial infarction (AMI-CS) remains unclear. Methods: The Cardiogenic Shock Working Group (CSWG) registry contains real-world data from patients hospitalized with CS across 17 clinical sites between 2016-2020. For this analysis, outcomes in CS patients were analyzed based the presence or absence of PAC, severity of CS (Society for Cardiovascular Angiography and Interventions or SCAI staging) and underlying shock etiology (AMI-CS or HF-CS). Results: Of the 1,890 CS patients included in this analysis, 1473 (77.9%) received a PAC during hospitalization, 593 (31.4%) had AMI-CS (PAC: 485 [81.8%], No PAC: 108 [18.2%]) and 1055 (55.8%) had HF-CS (PAC: 834 [79.1%], No PAC: 221 [20.9%]). Use of PAC was associated with greater drug/device utilization, mechanical ventilation and hospital length of stay, regardless of CS etiology (all p<0.001). Patients with a PAC had significantly less in-hospital mortality in the overall (31% vs 41%, p<0.001) and HF-CS cohort (21% vs 38%, p<0.001), with more significant differences seen in SCAI stages C (p<0.001) and D shock (p=0.01). Presence of PAC was not associated with in-hospital mortality among AMI-CS patients (43% vs 41%, p=0.63), regardless of SCAI stage (all p>0.1). PAC patients were more likely to undergo heart replacement therapy (HRT) when compared to those with no PAC (p<0.05) (Table). Conclusions: Using a large contemporary real-world dataset of CS, we identified that PAC use is associated with less in-hospital mortality and greater HRT compared to patients not receiving a PAC, particularly among HF-CS patients. Further, prospective efforts to define which CS populations derive the greatest benefit from PAC-guided interventions are needed.