Alessandro Sionis1, Mercedes Rivas-Lasarte1, Alexandre Mebazaa2, Tuukka Tarvasmäki3,4, Jordi Sans-Roselló1, Heli Tolppanen4,5, Marjut Varpula4, Raija Jurkko4, Marek Banaszewski6, Jose Silva-Cardoso7, Valentina Carubelli8, Matias Greve Lindholm9, John Parissis10, Jindrich Spinar11, Johan Lassus4, Veli-Pekka Harjola3, Josep Masip12. 1. Cardiology Department, Intensive Cardiac Care Unit, 16689Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain. 2. INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, Paris, France. 3. Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. 4. Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland. 5. Heart Center, Päijät-Häme Central Hospital, Lahti, Finland. 6. Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland. 7. Department of Cardiology, Faculty of Medicine, CINTESIS-Center for Health Technology and Services Research, University of Porto, São João Medical Center, Porto, Portugal. 8. Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy. 9. Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 10. Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece. 11. Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic. 12. Critical Care Department, Hospital Sant Joan Despi Moisès Broggi, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). METHODS: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. RESULTS: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. CONCLUSIONS: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.
BACKGROUND: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). METHODS: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. RESULTS: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. CONCLUSIONS: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.
Entities:
Keywords:
cardiac index; cardiac power index; cardiogenic shock; mortality; pulmonary artery catheter; stroke volume index
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