Pulmonary Artery Catheter Usage and Mortality in Cardiogenic Shock

Abstract

Mortality in cardiogenic shock (CS) remains prohibitively high despite recent advances in treatment. The extent of clinical benefit of the use of pulmonary artery catheters (PACs) in CS patients is still unclear. We hypothesize that the comprehensive assessment of PAC data is associated with reduced risk of in-hospital mortality in CS patients. 1,414 all-cause CS patients from the Cardiogenic Shock Working Group Registry, a national multicenter retrospective CS registry, were classified according to the Society for Cardiovascular Angiography and Intervention (SCAI) CS stages and evaluated for PAC use. PAC use was quantified by the presence of pulmonary artery saturation, pulmonary artery pressures and wedge pressure. We compared patients without any of these measurements (No PAC data), patients with at least one (Some PAC data) and patients with all these parameters and right atrial pressure (Complete PAC data). PAC usage was analyzed for association with in-hospital mortality in a multivariate logistic regression model. Of the total cohort of 1414 patients, 267 (18.88%) had no recorded PAC data, 549 (38.83%) had partially recorded PAC data, and 598 (42.29%) had complete PAC data. The majority of SCAI stage B (n=43, 93.5%) and C (n=132, 50.19%) had complete PAC data while the majority of SCAI stages D (n=361, 47.63%) and E (n=90, 42.45%) had some PAC data. After adjusting for institution in the total cohort, patients with complete PAC data had almost half the risk of mortality compared to those with no PAC data (OR 95%CI: 0.586, 0.418-0.822) and those with partial PAC data (OR 95%CI: 0.602, 0.467-0.813). The differences in mortality by PAC usage in the overall and SCAI stage cohorts are summarized in the figure below. These data suggest that using a PAC in CS patients, especially those in more critical condition, may decrease their risk of in-hospital mortality. This benefit could potentially be explained by the information provided by the PAC in developing a more appropriate treatment plan.