EARLY USE OF PULMONARY ARTERY CATHETER (PAC) IN ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK (AMICS)
Presenter
Juan Del Cid Fratti MD MS, MD MSc, The University of Washington, Peoria, IL
Juan Del Cid Fratti MD MS, MD MSc1, Pablo Paz, MD2, Gaspar Del Rio-Pertuz, MD2 and Erwin Argueta Sosa, MD2, (1)The University of Washington, Peoria, IL, (2)Texas Tech University Health Sciences Center, Lubbock, TX
Keywords: Acute Coronary Syndromes (ACS), Cardiogenic shock and Hemodynamic support
Background
The evidence for hemodynamic guided therapy using a pulmonary artery catheter (PAC) in patients with acute myocardial infarction cardiogenic shock (AMICS) is limited. We aim to describe outcomes of early-PAC in AMICS.
Methods
Retrospective analysis of the national inpatient sample (NIS) from 2016-2018. Patients with AMICS were identified. Early-PAC use was defined to be <24h from the index admission. The primary outcome was in-hospital mortality. The secondary outcomes included healthcare utilization burden and in-hospital complications. A multivariate regression analysis was constructed to adjust for confounders.
Results
We identified 431,435 patients with cardiogenic shock, from these 100,705 with AMICS. Early-PAC was used in 42% of patients with AMICS. Early-PAC use in CS was associated with decreased mortality, use of vasopressors, acute kidney injury (AKI) requiring renal replacement therapy (RRT), acute hepatic failure and discharge to a skilled nursing facility (SNF). Patients with early-PAC use had higher odds of mechanical circulatory support use (MCS) during the index admission, post-procedural bleeding but no increase of blood transfusion.
Conclusions
The early use of PAC in AMICS can aid therapeutics to decrease mortality, multiorgan failure and improve outcomes in this complex population with high mortality. We recommend early use of PAC for all patient with AMICS.
