Use of pulmonary artery catheters beneficial in cardiogenic shock due to acute HF
Key takeaways:
- Using a pulmonary artery catheter to help manage patients with cardiogenic shock due to acute heart failure was linked to improved survival.
- The benefit was greatest with use within 6 hours of admission.
In patients with cardiogenic shock due to acute heart failure, use of a pulmonary artery catheter was associated with reduced risk for in-hospital mortality, according to a retrospective observational study.
Manreet K. Kanwar, MD, co-director of the division of heart failure and pulmonary hypertension at the Cardiovascular Institute at Allegheny Health Network in Pittsburgh, and colleagues analyzed 1,055 patients (mean age, 62 years; 70% men) hospitalized between 2019 and 2021 for cardiogenic shock due to acute HF at 15 U.S. institutions participating in the Cardiogenic Shock Working Group registry.
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Patients were stratified by whether a pulmonary artery catheter was used to guide their management. In 79% of cases, it was. The primary outcome was in-hospital mortality.
Overall, the in-hospital mortality rate was 24.7%. The rate of adjusted in-hospital mortality risk was lower in those who had a pulmonary artery catheter inserted than in those who did not (22.2% vs. 29.8%; OR = 0.68; 95% CI, 0.5-0.94), according to the researchers.
The results were consistent across baseline and maximum Society for Cardiovascular Angiography and Interventions (SCAI) stages of cardiogenic shock, Kanwar and colleagues wrote, noting that the pulmonary artery catheter group was less likely to progress to SCAI stage E (22.9% vs. 29.4%; P = .002).
Pulmonary artery catheter use within 6 hours of admission occurred in 26% of those who had a pulmonary artery catheter inserted. These patients had a lower rate of in-hospital mortality compared with those who had a catheter inserted more than 48 hours after admission or did not receive a catheter (17.3% vs. 27.7%; OR = 0.54; 95% CI, 0.37-0.81).
“Pulmonary artery catheter recipients were more likely to receive pharmacologic and temporary mechanical circulatory support therapy, renal replacement therapy, mechanical ventilation as well as heart replacement therapy during their index hospitalization,” Kanwar and colleagues wrote. “This observational study supports pulmonary artery catheter use, as it was associated with decreased in-hospital mortality in cardiogenic shock due to acute HF, especially if performed within 6 hours of hospital admission.”
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