Table 1: Studies Evaluating Association Between Pulmonary Artery Catheter Use and Short-term Outcomes in Cardiogenic Shock Patients.
| Study | Study Design | Enrolment Period | Included Population | n | CS Aetiology | MCS Use | Outcome |
|---|---|---|---|---|---|---|---|
| Ranka et al. 2021[68] | Retrospective data from the Nationwide Readmissions Database US registry | January 2016–November 2017 | ICD-9-CM codes corresponding to CS diagnosis. Further analysis of patients with ICD-9 procedure codes for RHC |
23,6156 (9.6% RHC) | MI 44.1% Other 65.9% |
IABP 16.3% Percutaneous VAD 4.8% ELS 2.5% |
In-hospital propensity-matched mortality PAC 25.8% versus no-PAC 33.1% (adjusted OR 0.69; 95% CI [0.66–0.72]; p<0.001) |
| Garan et al. 2020[67] | Retrospective data from the first eight sites contributing to the Cardiogenic Shock Working Group registry in the US | 2016–2019 | CS definition: sustained episode of SBP <90 mmHg for at least 30 min or use of vasoactive agents and/or cardiac index <2.2 l/min/m2 determined to be secondary to cardiac dysfunction, in the absence of hypovolaemia; or use of an MCS device for clinically suspected CS | 858 (69.7% complete PAC) | MI 34.9% HF 50.4% Other 12.6% |
IABP 54.5% Impella 29% ECMO 23.6% Multiple MCS 21.8% |
In-hospital mortality complete PAC assessment 25% versus no-PAC 33.8% (adjusted OR 0.64; 95% CI [0.43–0.94]) |
| Hernandez et al. 2019[66] | Retrospective data from the National Inpatient Sample database in the US | 2004–2014 | ICD-9-CM codes corresponding to HF and CS diagnosis. Further analysis of patients with ICD-9 procedure codes for PAC monitoring |
91,5416 (8.7% PAC) |
Not specified | MCS (not further specified) 26.2% | In-hospital propensity-matched mortality PAC 34.9% versus no-PAC 37% (adjusted OR 0.91; 95% CI [0.87–0.97]; p=0.001) |
| Sionis et al. 2019[70] | Subanalysis of the prospective European CardShock study | October 2010–December 2012 | Consecutive patients ≥18 years old within 6 hours from identification of CS, defined as evidence of an acute cardiac cause and:
Exclusion criteria: shock after cardiac or noncardiac surgery or on-going haemodynamically significant arrhythmia |
219 (62.6% PAC) |
MI 80.8% Mechanical complication 8.7% Chronic HF 10.5% |
IABP 55.7% ECMO 1.8% LVAD 4.1% |
30-day mortality PAC 42% versus no-PAC 24% (p=0.2) Propensity-matched 30-day mortality 46% versus 42% (adjusted HR 1.17; 95% CI [0.59–2.32]; p=0.66) |
| O'Neill et al. 2018[71] | Subanalysis of the Impella IQ US prospective registry | 2009–2016 | AMICS defined as SBP <90 mmHg, or need for vasopressors to maintain SBP >90 mmHg, in the setting of prolonged chest discomfort and associated with ST segment elevation, new left bundle branch block, or ST T-wave changes compatible with non-ST-elevation MI | 13,984 (37.3% PAC) | MI 100% | Impella 100% | Mortality before explantation PAC 37% versus no-PAC 51% (p<0.0001). Multivariate analysis OR 0.60; 95% CI [0.53–0.68]; p<0.0001 |
| Rossello et al. 2017[69] | Prospective cohort investigation of a single-centre Spanish ICCU | December 2005–May 2009 | All consecutive patients presenting with a first admission of CS, defined as: SBP <90 mmHg for 30 min or the need for vasopressor therapy to maintain adequate perfusion pressure and signs of hypoperfusion | 129 (64.3% PAC) |
MI 50% CMP 22% Other 28% |
IABP 32% LVAD 2% |
30-day mortality with PAC 55% versus no PAC 78% (p=0.010; adjusted HR 0.55; 95% CI [0.35–0.86]; p=0.008) Long-term mortality (median follow-up 63 months) lower (HR 0.57; 95% CI [0.37–0.86]; p=0.007; adjusted HR 0.63; 95% CI [0.41–0.97]; p=0.035 |
AMICS = acute MI cardiogenic shock; CMP = cardiomyopathy; CS = cardiogenic shock; ECMO = extracorporeal membrane oxygenation; ELS = extracorporeal life support; HF = heart failure; IABP = Intra-aortic balloon pump; ICCU: Intensive Cardiac Care Unit; ICD-9-CM = ICD-9 Clinical Modification; LVAD = left ventricular assist device; MCS = mechanical circulatory support; PAC = pulmonary artery catheter; RHC = right heart catheterisation; SBP = systolic blood pressure; VAD = ventricular assist device.