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Pulmonary Artery Catheter Use and Outcomes in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock Treated With Impella (a Nationwide Analysis from the United States).
- Source :
-
The American journal of cardiology [Am J Cardiol] 2023 Sep 15; Vol. 203, pp. 304-314. Date of Electronic Publication: 2023 Jul 28. - Publication Year :
- 2023
-
Abstract
- The role of continuous hemodynamic assessment with pulmonary artery (PA) catheter placement in cardiogenic shock (CS) remains debated. We aimed to assess the association between PA catheter placement and clinical outcomes in patients with CS secondary to ST-elevation myocardial infarction (STEMI) treated with an intravascular microaxial flow pump. We identified patients hospitalized with STEMI complicated by CS on mechanical circulatory support with an intravascular microaxial flow pump (Impella, Abiomed, Danvers, Massachusetts) using the National Inpatient Sample database and compared the outcomes in those treated with and without PA catheters. The primary outcome was in-hospital mortality. The secondary outcomes included in-hospital complications, hospital length of stay, inpatient costs, and temporal trends. The total cohort included 14,635 hospitalizations for STEMI complicated by CS treated with Impella between 2016 and 2020, of whom 5,505 (37.6%) received PA catheters. Over the study period, the use of PA catheters increased significantly from 25.9% to 41.8% (p <subscript>trend</subscript> <0.01). Similarly, the use of Impella increased from 9.9% to 18.9% (p <subscript>trend</subscript> <0.01). After adjustment for baseline characteristics using a multivariate logistic regression analysis, PA catheter use was associated with lower in-hospital mortality (adjusted odds ratio 0.80, 95% confidence interval 0.67 to 0.96, p = 0.01) and similar cardiovascular, neurologic, renal, and hematologic complications; length of stay; and inpatient costs compared with no PA catheter use. In conclusion, PA catheter use in patients with STEMI complicated by CS treated with Impella is associated with reduced in-hospital mortality and similar complication rates. Given the mortality benefit, further research is necessary to optimize PA catheter use in patients with STEMI with CS.<br />Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
United States epidemiology
Shock, Cardiogenic epidemiology
Shock, Cardiogenic etiology
Shock, Cardiogenic therapy
Pulmonary Artery
Catheters adverse effects
Hospital Mortality
Treatment Outcome
Retrospective Studies
ST Elevation Myocardial Infarction complications
ST Elevation Myocardial Infarction therapy
Heart-Assist Devices adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 203
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 37517125
- Full Text :
- https://doi.org/10.1016/j.amjcard.2023.06.117