Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock.

BACKGROUND: Pulmonary artery catheters (PACs) are increasingly used to guide management decisions in cardiogenic shock (CS). The goal of this study was to determine if PAC use was associated with a lower risk of in-hospital mortality in CS owing to acute heart failure (HF-CS). METHODS AND RESULTS: This multicenter, retrospective, observational study included patients with CS hospitalized between 2019 and 2021 at 15 US hospitals participating in the Cardiogenic Shock Working Group registry. The primary end point was in-hospital mortality. Inverse probability of treatment-weighted logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CI), accounting for multiple variables at admission. The association between the timing of PAC placement and in-hospital death was also analyzed. A total of 1055 patients with HF-CS were included, of whom 834 (79%) received a PAC during their hospitalization. In-hospital mortality risk for the cohort was 24.7% (n = 261). PAC use was associated with lower adjusted in-hospital mortality risk (22.2% vs 29.8%, OR 0.68, 95% CI 0.50-0.94). Similar associations were found across SCAI stages of shock, both at admission and at maximum SCAI stage during hospitalization. Early PAC use (≤6 hours of admission) was observed in 220 PAC recipients (26%) and associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, OR 0.54, 95% CI 0.37-0.81). CONCLUSIONS: This observational study supports PAC use, because it was associated with decreased in-hospital mortality in HF-CS, especially if performed within 6 hours of hospital admission. CONDENSED ABSTRACT: An observational study from the Cardiogenic Shock Working Group registry of 1055 patients with HF-CS showed that pulmonary artery catheter (PAC) use was associated with a lower adjusted in-hospital mortality risk (22.2% vs 29.8%, odds ratio 0.68, 95% confidence interval 0.50-0.94) compared with outcomes in patients managed without PAC. Early PAC use (≤6 hours of admission) was associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, odds ratio 0.54, 95% confidence interval 0.37-0.81).

Clinical Outcome of TAVR vs. SAVR in Patients With Cardiac Amyloidosis.

Data regarding the clinical outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in cardiac amyloidosis are lacking. Our study aimed to look at the clinical outcomes of TAVR vs. SAVR in patients with cardiac amyloidosis. METHOD: We queried the National Inpatient Sample database for the years 2009-2014 using validated ICD-9-CM codes for TAVR and SAVR. Propensity score matching (1:1; PSM) was performed and in-hospital outcomes were compared between matched cohorts. RESULTS: Before PSM, the TAVR group had a higher hospitalization cost ($59,192 vs. $56,171.1, p = 0.001) and in-hospital mortality (4.24% vs. 3.27%, p = 0.001) compared to the SAVR group. After PSM, mortality (41.3% vs. 5.81%, p = 0.001) and hospitalization cost ($5907 vs. $6280, p = 0.001) was higher in the SAVR group. Length of stay was shorter in the TAVR group compared to SAVR group before (8.7 vs 11.4 p = 0.001) and after (8.7 vs 0.13.7, p = 0.001) PSM. After PSM, the incidence of acute myocardial infarction (10.10% vs. 17.57%, p = 0.001), acute kidney injury (20.67% vs. 31.40%, p = 0.001) and major bleeding (39.18% vs. 47.90%, p = 0.001) were higher in the SAVR group while the TAVR group had a higher incidence of the stroke (12.47% vs. 11.97%, p = 0.001), vascular complication (14.59% vs. 12.97%, p = 0.001), and permanent pacemaker implantation (10.45% vs. 8.48%, p = 0.001). CONCLUSION: In CA patients, in-hospital mortality and hospitalization costs were higher in the SAVR group than in the TAVR group, while the length of stay was shorter in the TAVR group.