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Current use and impact on 30-day mortality of pulmonary artery catheter in cardiogenic shock patients: results from the CardShock Study.

Session Advanced heart failure: the touch ahead

Speaker Mercedes Rivas Lasarte

Event : ESC Congress 2017

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Diagnostic Methods
  • Session type : Rapid Fire Abstracts

Authors : M Rivas Lasarte (Barcelona,ES), J Sans-Rosello (Barcelona,ES), M Vila (Barcelona,ES), H Tolppanen (Helsinki,FI), J Lassus (Helsinki,FI), M Lindholm (Copenhagen,DK), A Mebazaa (Paris,FR), V-P Harjola (Helsinki,FI), A Sionis (Barcelona,ES)

Authors:
M. Rivas Lasarte1 , J. Sans-Rosello1 , M. Vila1 , H. Tolppanen2 , J. Lassus2 , M. Lindholm3 , A. Mebazaa4 , V.-P. Harjola2 , A. Sionis1 , 1Hospital de la Santa Creu i Sant Pau, Cardiology Department - Barcelona - Spain , 2Helsinki University Central Hospital, Cardiology department - Helsinki - Finland , 3Rigshospitalet - Copenhagen University Hospital - Copenhagen - Denmark , 4Inserm UMR-S 942 - Paris - France ,

On behalf: CardShock Investigators

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1046

Background: Cardiogenic Shock (CS) is the most life-threatening manifestation of heart failure (HF). Its complexity and high mortality, near 40%, would justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Randomized clinical trials have failed to demonstrate clinical benefit of PAC use in critically ill patients, but CS patients were grossly underrepresented.

Purpose: To describe the real-world use of PAC in patients with CS and to evaluate its prognostic impact on short-term mortality.

Methods: This is a sub-study of the CardShock study a prospective, multicenter cohort aimed to describe the contemporary clinical and management characteristics in patients with CS. The use of PAC was within the discretion of the physician in charge. The primary endpoint was overall 30-day mortality.

Results: The CardShock study included 219 patients; PAC was used in 82 patients (37.4%). Management was more aggressive in those with PAC (table). Overall 30-day mortality was 38.6%. PAC use did not affect mortality [OR: 1.24 (95% CI 0.60–2.56) p=0.56], in a multivariate analysis adjusted by a propensity score (including the history of prior myocardial infarction, inotropic use at admission, acute coronary syndrome as the etiology of shock, mechanical ventilation, and assist devices use).

Conclusions: PAC is used in 1/3 of CS patients. They are characterized by a prior poorer prognosis and by more aggressive management. PAC use was not associated with 30-day mortality.

Table. Characteristics of the study popu
PAC groupNon-PAC groupP value
(82 patients, 37.4%)(137 patients, 62.6%)
Age, mean (SD)66.7 (0.8)67.7 (1.0)0.09
Male, n (%)64 (78.05)98 (71.53)0.288
Inotrope use at admission*, n (%)41 (50.00)36 (26.28)0.000
Confusion at admission, n (%)63 (77.78)85 (62.96)0.023
Baseline LVEF, mean (SD)31.43 (1.73)33.94 (1.20)0.220
IABP, n (%)56 (76.71)57 (46.34)0.000
ECMO and LVAD, n (%)6 (7.41)5 (3.73)0.236
Mechanical ventilation, n (%)73 (89.02)64 (47.06)0.000
CRR therapy, n (%)18 (21.95)12 (9.02)0.008
30-day mortality, n (%)35 (42.68)49 (35.77)0.308
PAC: pulmonary artery catheter; SD: standard deviation; LVEF: left ventricular ejection fraction, IABP: intra-aortic balloon pump; ECMO: extracorporeal membrane oxygenation; LVAD: left ventricular assist device; CRR: continuous renal replacement.
Figure 1. Kaplan-Meier curves for 30-day su

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