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Pulmonary Artery Catheterization in Cardiogenic Shock – a propensity matched analysis on management and prognostic impact
Session:
Comunicações Orais - Sessão 01 - Choque cardiogénico e transplante cardíaco
Speaker:
Ana Rita Bello
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Rita Bello; Rita Almeida Carvalho; João Presume; Mariana Sousa Paiva; Rita Lima; Rita Sousa Barbosa; Samuel Azevedo; Débora Correia; Catarina Brízido; Christopher Strong; Jorge Ferreira; António Tralhão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Even though previous trials failed to show outcome improvement in cardiogenic shock (CS) patients managed with a pulmonary artery catheter (PAC), recent observational studies suggest that its use may allow tailored treatment decisions and bring prognostic benefits to this population.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To analyze PAC-guided patient management trends, and identify differences in mortality between CS patients who received a PAC vs those who did not.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Retrospective single-center analysis of consecutive CS patients admitted to our cardiac intensive care unit (CICU) between 2017 and 2023. Historically, PAC insertion transitioned from being at the discretion of the attending cardiac intensivist to becoming encouraged for CS from 2021 onwards. Firstly, PAC patients’ strategy modification according to the obtained invasive hemodynamic data was analyzed. Secondly, PAC patients were propensity score paired in a 1:1 ratio with a group of non-PAC patients, matched by age, diabetes, chronic kidney disease, CS etiology, SCAI class at admission, maximum lactate and presence of cardiac arrest (mean standardized difference <10% for matching variables). Matched patients were compared for 30-day all-cause mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> From a total of 286 CS patients, 81 (28%) received a PAC. For these patients, invasive hemodynamic phenotyping changed medical approach in 57 (70%) patients: prompting fluid management modification in 46 (80%), initiation of a different inotropic drug in 11 (19%) and a change on vasoactive drug class in 25 patients (44%). Regarding the use of mechanical circulatory support (MCS), PAC was useful: for guiding MCS choice in 4 patients; deciding not to proceed with MCS in 3 patients; helping MCS weaning in 7 patients; and completing heart transplantation or LVAD evaluation in 8 patients. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">After propensity matching, a total of 160<strong> </strong>patients (80 PAC and 80 non-PAC) were included (mean age of 63±17 years, 114 [71%] male). In 52% (n=83), etiology for CS was acute myocardial infarction. Median lactate and most frequent SCAI class at admission were 3.3 [1.8 – 6.0] mmol/L and C (n = 100; 63%), respectively. Cardiac arrest occurred in 48 (30%) patients. Overall, 30-day mortality was 41% (n=66). Patients in the PAC group demonstrated decreased mortality at 30-days (33% vs 50%, p = 0.025). Survival analysis through Kaplan-Meier curves showed improved survival at 30 days in the PAC-guided patient group (<span style="font-size:8.0pt">[CB1] </span><span style="font-size:8.0pt">[AT2] </span>log-rank p=0.005) - figure 1.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>PAC had an impact on CS management in<strong> </strong>70% of cases and also on 30-day mortality, compared to non-PAC patients. Invasive hemodynamic assessment contributes to more tailored treatment decisions and therefore may have an impact in CS outcomes. Further randomized studies and prospective analysis are necessary to confirm these results.</span></span></p>
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