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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 Poster Session 1

Speaker Mercedes Rivas Lasarte

Event : Heart Failure 2017

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure– Treatment
  • Session type : Poster Session

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 Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 35

Background: Cardiogenic Shock (CS) is the most life-threatening manifestation of heart failure (HF). Its complexity and high mortality, would justify the need for invasive monitoring with a pulmonary artery catheter (PAC) that may allow the clinician to establish an accurate diagnosis at all times and to guide treatment. Randomized clinical trials have failed to demonstrate clinical benefit of PAC use in critically ill patients, but CS patients were grossly underrepresented.

Purpose: This study aims to describe the real-world use of PAC in a contemporary cohort of patients with CS and to evaluate its prognostic impact on 30-day mortality.

Methods: This is a sub-study of the previous published CardShock study an observational, prospective, multicenter cohort of patients with CS. The use of PAC was within the discretion of the physician in charge.

Results: The CardShock study included 219 patients; PAC was used in 82 patients (37.4%). The management was more aggressive in those with PAC (table). Overall 30-day mortality was 38.6%, with no differences between PAC and non-PAC patients (figure).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, etiology of shock, mechanical ventilation, and assist device use).

Conclusions: This study revealed that 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.

PAC group

(82 patients, 37.4%)

Non-PAC group

(137 patients, 62.6%)

P value

SBP at admission, mean (SD)

79.61 (1.75)

76.47 (1.05)

0.10

Inotrope use at admission*, n (%)

41 (50.00)

36 (26.28)

0.000

Confusion at admission, n (%)

63 (77.78)

85 (62.96)

0.02

Baseline LVEF, mean (SD)

31.43 (1.73)

33.94 (1.20)

0.22

IABP, n (%)

56 (76.71)

57 (46.34)

0.000

ECMO and LVAD, n (%)

6 (7.41)

5 (3.73)

0.23

Mechanical ventilation, n (%)

73 (89.02)

64(47.06)

0.000

30-day mortality, n (%)

35 (42.68)

49 (35.77)

0.31

PAC: pulmonary artery catheter; SD: standard deviation; SBP: systolic blood pressure; HR: heart rate; ACS: acute coronary syndrome, LVEF: left ventricular ejection fraction, IABP: intra-aortic balloon pump; ECMO: extracorporeal membrane oxygenation; LVAD: left ventricular assist device, CRR: continuous renal replacement. *Inotrope use refers to dobutamine, adrenaline, levosimendan or milrinone use.

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