Impact of pulmonary artery catheterization in patients with acute myocardial infarction cardiogenic shock

Abstract

Acute myocardial infarction (AMI) remains one of the most common causes for cardiogenic shock (CS), with high inpatient mortality (40–50 %). Studies have reported the use of pulmonary artery catheters (PACs) in decompensated heart failure, but contemporary data on their use to guide management of AMI-CS and in different SCAI stages of CS are lacking. We investigated the association of PACs and clinical outcomes in AMI-CS. In this retrospective study from a large healthcare system (MedStar Health, 10 hospitals) from 2014 to 2021, patients were grouped according to presentation as ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) and on the basis of SCAI classification. In-hospital mortality was assessed among patients with and without PACs using propensity-matched analysis. A total of 2585 patients were included, of whom 797 had STEMI and 1788 had NSTEMI. Overall, 517 patients underwent PAC placement; PAC utilization rates were 19.7 % in the STEMI group and 20.4 % in the NSTEMI group. Overall, among patients with AMI-CS, we observed that in-hospital mortality was higher in patients who did not receive PACs during hospitalization (35.9 % vs 25.9 %, p < 0.001). After propensity-matching 484 patients in the PAC group to 484 in the no-PAC group, the no-PAC group still showed higher mortality (34.9 % vs 26.7 %, p = 0.005). Utilization of MCS devices was higher in patients with PAC. In conclusion, our results suggest an advantage in utilizing PACs in AMI-CS patients to identify early CS stages and offer appropriate therapies. Therefore, PACs should be routinely used in for this population.