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)

Authors

Mahmoud Ismayl, Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota. Electronic address: ismayl.mahmoud@mayo.edu.
Yasin Hussain, Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
Ahmed Aboeata, Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska.
Ryan W. Walters, Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska.
Srihari S. Naidu, Department of Cardiovascular Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York.
John C. Messenger, Department of Cardiovascular Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Mir B. Basir, Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
Sunil V. Rao, Department of Cardiovascular Medicine, NYU Langone Health System, New York, New York.
Andrew M. Goldsweig, Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts.
S Elissa Altin, Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.

Author Type(s)

Faculty

DOI

10.1016/j.amjcard.2023.06.117

Journal Title

The American Journal of Cardiology

First Page

304

Last Page

314

Document Type

Article

Publication Date

9-15-2023

Department

Medicine

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 <0.01). Similarly, the use of Impella increased from 9.9% to 18.9% (p <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.

Recommended Citation

Ismayl, M., Hussain, Y., Aboeata, A., Walters, R. W., Naidu, S. S., Messenger, J. C., Basir, M. B., Rao, S. V., Goldsweig, A. M., & Altin, S. E. (2023). 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). The American Journal of Cardiology, 203, 304-314. https://doi.org/10.1016/j.amjcard.2023.06.117