Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality
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). Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking...
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| Veröffentlicht in: | JACC. Heart failure 2020-11, Vol.8 (11), p.903-913 |
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| creator | Garan, A. Reshad Kanwar, Manreet Thayer, Katherine L. Whitehead, Evan Zweck, Elric Hernandez-Montfort, Jaime Mahr, Claudius Haywood, Jillian L. Harwani, Neil M. Wencker, Detlef Sinha, Shashank S. Vorovich, Esther Abraham, Jacob O’Neill, William Burkhoff, Daniel Kapur, Navin K. |
| description | 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).
Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking.
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).
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 |
| doi_str_mv | 10.1016/j.jchf.2020.08.012 |
| format | Article |
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Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking.
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).
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).
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.
[Display omitted]</description><identifier>ISSN: 2213-1779</identifier><identifier>EISSN: 2213-1787</identifier><identifier>DOI: 10.1016/j.jchf.2020.08.012</identifier><identifier>PMID: 33121702</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>cardiogenic shock ; hemodynamics ; mechanical circulatory support ; pulmonary artery catheter</subject><ispartof>JACC. Heart failure, 2020-11, Vol.8 (11), p.903-913</ispartof><rights>2020 American College of Cardiology Foundation</rights><rights>Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c449t-368a0bf0cf2af1acec58abee93a5de7ad25e7e329b58dd919079a958a1452843</citedby><cites>FETCH-LOGICAL-c449t-368a0bf0cf2af1acec58abee93a5de7ad25e7e329b58dd919079a958a1452843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33121702$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garan, A. Reshad</creatorcontrib><creatorcontrib>Kanwar, Manreet</creatorcontrib><creatorcontrib>Thayer, Katherine L.</creatorcontrib><creatorcontrib>Whitehead, Evan</creatorcontrib><creatorcontrib>Zweck, Elric</creatorcontrib><creatorcontrib>Hernandez-Montfort, Jaime</creatorcontrib><creatorcontrib>Mahr, Claudius</creatorcontrib><creatorcontrib>Haywood, Jillian L.</creatorcontrib><creatorcontrib>Harwani, Neil M.</creatorcontrib><creatorcontrib>Wencker, Detlef</creatorcontrib><creatorcontrib>Sinha, Shashank S.</creatorcontrib><creatorcontrib>Vorovich, Esther</creatorcontrib><creatorcontrib>Abraham, Jacob</creatorcontrib><creatorcontrib>O’Neill, William</creatorcontrib><creatorcontrib>Burkhoff, Daniel</creatorcontrib><creatorcontrib>Kapur, Navin K.</creatorcontrib><title>Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality</title><title>JACC. Heart failure</title><addtitle>JACC Heart Fail</addtitle><description>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).
Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking.
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).
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).
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.
[Display omitted]</description><subject>cardiogenic shock</subject><subject>hemodynamics</subject><subject>mechanical circulatory support</subject><subject>pulmonary artery catheter</subject><issn>2213-1779</issn><issn>2213-1787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kEFLAzEQhYMotmj_gAfJ0cuuSXa3mwUvpagtVCxY8BjSZLZN3d3UJFV69ZebUvXoXN4MvPdgPoSuKEkpocPbTbpR6zplhJGU8JRQdoL6jNEsoSUvT__2suqhgfcbEocXlHN-jnpZRhktCeujr7Fttw0EwBNord53sjUKz52tTWO6FX41YY3nu6a1nXR7PHIBooxlWMeM89h08XDa2BV0MfiytuoNTz0eeW-VkQH0sWJmP8HhaZdMrN-aIBv8ZF0UE_aX6KyWjYfBj16gxcP9YjxJZs-P0_Folqg8r0KSDbkky5qomsmaSgWq4HIJUGWy0FBKzQooIWPVsuBaV7QiZSWr6KF5wXieXaCbY-3W2fcd-CBa4xU0jezA7rxgeTHMKSvzIlrZ0aqc9d5BLbbOtPF_QYk40BcbcaAvDvQF4SLSj6Hrn_7dsgX9F_llHQ13RwPEJz8MOOGVgU6BNg5UENqa__q_AXt7l70</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Garan, A. Reshad</creator><creator>Kanwar, Manreet</creator><creator>Thayer, Katherine L.</creator><creator>Whitehead, Evan</creator><creator>Zweck, Elric</creator><creator>Hernandez-Montfort, Jaime</creator><creator>Mahr, Claudius</creator><creator>Haywood, Jillian L.</creator><creator>Harwani, Neil M.</creator><creator>Wencker, Detlef</creator><creator>Sinha, Shashank S.</creator><creator>Vorovich, Esther</creator><creator>Abraham, Jacob</creator><creator>O’Neill, William</creator><creator>Burkhoff, Daniel</creator><creator>Kapur, Navin K.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202011</creationdate><title>Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality</title><author>Garan, A. Reshad ; Kanwar, Manreet ; Thayer, Katherine L. ; Whitehead, Evan ; Zweck, Elric ; Hernandez-Montfort, Jaime ; Mahr, Claudius ; Haywood, Jillian L. ; Harwani, Neil M. ; Wencker, Detlef ; Sinha, Shashank S. ; Vorovich, Esther ; Abraham, Jacob ; O’Neill, William ; Burkhoff, Daniel ; Kapur, Navin K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c449t-368a0bf0cf2af1acec58abee93a5de7ad25e7e329b58dd919079a958a1452843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>cardiogenic shock</topic><topic>hemodynamics</topic><topic>mechanical circulatory support</topic><topic>pulmonary artery catheter</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garan, A. Reshad</creatorcontrib><creatorcontrib>Kanwar, Manreet</creatorcontrib><creatorcontrib>Thayer, Katherine L.</creatorcontrib><creatorcontrib>Whitehead, Evan</creatorcontrib><creatorcontrib>Zweck, Elric</creatorcontrib><creatorcontrib>Hernandez-Montfort, Jaime</creatorcontrib><creatorcontrib>Mahr, Claudius</creatorcontrib><creatorcontrib>Haywood, Jillian L.</creatorcontrib><creatorcontrib>Harwani, Neil M.</creatorcontrib><creatorcontrib>Wencker, Detlef</creatorcontrib><creatorcontrib>Sinha, Shashank S.</creatorcontrib><creatorcontrib>Vorovich, Esther</creatorcontrib><creatorcontrib>Abraham, Jacob</creatorcontrib><creatorcontrib>O’Neill, William</creatorcontrib><creatorcontrib>Burkhoff, Daniel</creatorcontrib><creatorcontrib>Kapur, Navin K.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garan, A. Reshad</au><au>Kanwar, Manreet</au><au>Thayer, Katherine L.</au><au>Whitehead, Evan</au><au>Zweck, Elric</au><au>Hernandez-Montfort, Jaime</au><au>Mahr, Claudius</au><au>Haywood, Jillian L.</au><au>Harwani, Neil M.</au><au>Wencker, Detlef</au><au>Sinha, Shashank S.</au><au>Vorovich, Esther</au><au>Abraham, Jacob</au><au>O’Neill, William</au><au>Burkhoff, Daniel</au><au>Kapur, Navin K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality</atitle><jtitle>JACC. Heart failure</jtitle><addtitle>JACC Heart Fail</addtitle><date>2020-11</date><risdate>2020</risdate><volume>8</volume><issue>11</issue><spage>903</spage><epage>913</epage><pages>903-913</pages><issn>2213-1779</issn><eissn>2213-1787</eissn><abstract>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).
Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking.
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).
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).
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.
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| subjects | cardiogenic shock hemodynamics mechanical circulatory support pulmonary artery catheter |
| title | Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality |
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