Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock
Abstract Aims The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction‐cardiogenic shock (AMI‐CS). Methods and results A retrospective cohort of AMI‐CS admissions using the National Inpatient Sample (2000–2014) was identified. Admi...
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| Format: | Article |
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Wiley
2020-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12652 |
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| author | Saraschandra Vallabhajosyula Aditi Shankar Sri Harsha Patlolla Abhiram Prasad Malcolm R. Bell Jacob C. Jentzer Shilpkumar Arora Saarwaani Vallabhajosyula Bernard J. Gersh Allan S. Jaffe David R. Holmes Jr Shannon M. Dunlay Gregory W. Barsness |
| author_facet | Saraschandra Vallabhajosyula Aditi Shankar Sri Harsha Patlolla Abhiram Prasad Malcolm R. Bell Jacob C. Jentzer Shilpkumar Arora Saarwaani Vallabhajosyula Bernard J. Gersh Allan S. Jaffe David R. Holmes Jr Shannon M. Dunlay Gregory W. Barsness |
| author_sort | Saraschandra Vallabhajosyula |
| collection | DOAJ |
| description | Abstract Aims The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction‐cardiogenic shock (AMI‐CS). Methods and results A retrospective cohort of AMI‐CS admissions using the National Inpatient Sample (2000–2014) was identified. Admissions with concomitant cardiac surgery or non‐AMI aetiology for cardiogenic shock were excluded. The outcomes of interest were in‐hospital mortality, resource utilization, and temporal trends in cohorts with and without PAC use. In the non‐PAC cohort, the use and outcomes of right heart catheterization was evaluated. Multivariable regression and propensity matching was used to adjust for confounding. During 2000–2014, 364 001 admissions with AMI‐CS were included. PAC was used in 8.1% with a 75% decrease during over the study period (13.9% to 5.4%). Greater proportion of admissions to urban teaching hospitals received PACs (9.5%) compared with urban non‐teaching (7.1%) and rural hospitals (5.4%); P < 0.001. Younger age, male sex, white race, higher comorbidity, noncardiac organ failure, use of mechanical circulatory support, and noncardiac support were independent predictors of PAC use. The PAC cohort had higher in‐hospital mortality (adjusted odds ratio 1.07 [95% confidence interval 1.04–1.10]), longer length of stay (10.9 ± 10.9 vs. 8.2 ± 9.3 days), higher hospitalization costs ($128 247 ± 138 181 vs. $96 509 ± 116 060), and lesser discharges to home (36.3% vs. 46.4%) (all P < 0.001). In 6200 propensity‐matched pairs, in‐hospital mortality was comparable between the two cohorts (odds ratio 1.01 [95% confidence interval 0.94–1.08]). Right heart catheterization was used in 12.5% of non‐PAC admissions and was a marker of greater severity but did not indicate worse outcomes. Conclusions In AMI‐CS, there was a 75% decrease in PAC use between 2000 and 2014. Admissions receiving a PAC were a higher risk cohort with worse clinical outcomes. |
| format | Article |
| id | doaj-art-87a5c703c9594f8ea083c001b0a7f598 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-87a5c703c9594f8ea083c001b0a7f5982025-02-03T10:25:46ZengWileyESC Heart Failure2055-58222020-06-01731234124510.1002/ehf2.12652Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shockSaraschandra Vallabhajosyula0Aditi Shankar1Sri Harsha Patlolla2Abhiram Prasad3Malcolm R. Bell4Jacob C. Jentzer5Shilpkumar Arora6Saarwaani Vallabhajosyula7Bernard J. Gersh8Allan S. Jaffe9David R. Holmes Jr10Shannon M. Dunlay11Gregory W. Barsness12Department of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Medicine Texas Health Presbyterian Hospital Dallas Dallas TX 75231 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADivision of Cardiovascular Medicine, Department of Medicine Case Western Reserve University School of Medicine Cleveland OH 44106 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55905 USAAbstract Aims The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction‐cardiogenic shock (AMI‐CS). Methods and results A retrospective cohort of AMI‐CS admissions using the National Inpatient Sample (2000–2014) was identified. Admissions with concomitant cardiac surgery or non‐AMI aetiology for cardiogenic shock were excluded. The outcomes of interest were in‐hospital mortality, resource utilization, and temporal trends in cohorts with and without PAC use. In the non‐PAC cohort, the use and outcomes of right heart catheterization was evaluated. Multivariable regression and propensity matching was used to adjust for confounding. During 2000–2014, 364 001 admissions with AMI‐CS were included. PAC was used in 8.1% with a 75% decrease during over the study period (13.9% to 5.4%). Greater proportion of admissions to urban teaching hospitals received PACs (9.5%) compared with urban non‐teaching (7.1%) and rural hospitals (5.4%); P < 0.001. Younger age, male sex, white race, higher comorbidity, noncardiac organ failure, use of mechanical circulatory support, and noncardiac support were independent predictors of PAC use. The PAC cohort had higher in‐hospital mortality (adjusted odds ratio 1.07 [95% confidence interval 1.04–1.10]), longer length of stay (10.9 ± 10.9 vs. 8.2 ± 9.3 days), higher hospitalization costs ($128 247 ± 138 181 vs. $96 509 ± 116 060), and lesser discharges to home (36.3% vs. 46.4%) (all P < 0.001). In 6200 propensity‐matched pairs, in‐hospital mortality was comparable between the two cohorts (odds ratio 1.01 [95% confidence interval 0.94–1.08]). Right heart catheterization was used in 12.5% of non‐PAC admissions and was a marker of greater severity but did not indicate worse outcomes. Conclusions In AMI‐CS, there was a 75% decrease in PAC use between 2000 and 2014. Admissions receiving a PAC were a higher risk cohort with worse clinical outcomes.https://doi.org/10.1002/ehf2.12652Cardiogenic shockAcute myocardial infarctionHeart failurePulmonary artery catheterizationRight heart catheterizationCardiac intensive care unit |
| spellingShingle | Saraschandra Vallabhajosyula Aditi Shankar Sri Harsha Patlolla Abhiram Prasad Malcolm R. Bell Jacob C. Jentzer Shilpkumar Arora Saarwaani Vallabhajosyula Bernard J. Gersh Allan S. Jaffe David R. Holmes Jr Shannon M. Dunlay Gregory W. Barsness Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock ESC Heart Failure Cardiogenic shock Acute myocardial infarction Heart failure Pulmonary artery catheterization Right heart catheterization Cardiac intensive care unit |
| title | Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock |
| title_full | Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock |
| title_fullStr | Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock |
| title_full_unstemmed | Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock |
| title_short | Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock |
| title_sort | pulmonary artery catheter use in acute myocardial infarction cardiogenic shock |
| topic | Cardiogenic shock Acute myocardial infarction Heart failure Pulmonary artery catheterization Right heart catheterization Cardiac intensive care unit |
| url | https://doi.org/10.1002/ehf2.12652 |
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