Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study

• Published in: Journal of cardiac failure 2023-05, Vol.29 (5), p.745-756
• Main Authors: Ortega-Hernández, Jorge A., González-Pacheco, Héctor, Gopar-Nieto, Rodrigo, Briseño-De-La-Cruz, Jose Luis, Sierra-Lara, Daniel, Araiza-Garaygordobil, Diego, Eid-Lidt, Guering, Mendoza-García, Salvador, Manzur-Sandoval, Daniel, Altamirano-Castillo, Alfredo, Ontiveros-Mercado, Heriberto, Aguilar-Montaño, Kladyer Melissa, Rosas-Martínez, Manuel, Hernández-Montfort, Jaime, Arias-Mendoza, Alexandra
• Format: Article
• Language: English
• Subjects: Cardiogenic shock; congestion; Heart Failure; Hemodynamics; Hospital Mortality; Humans; invasive hemodynamics; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; PAC; SCAI; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - etiology
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.425

•Persistent or new congestion within the first 24 hours of cardiogenic shock is associated with worse outcomes.•BiV or persistent congestion and higher SCAI stages are associated with worsening hemodynamics.•Incorporating hemodynamic and congestion assessment plus SCAI stages in AMI-CS could potentially impact clinical outcomes by optimizing guideline-directed therapies. Cardiogenic shock (CS) commonly complicates the management of acute myocardial infarction (AMI), and it results in high mortality rates. Pulmonary artery catheter (PAC) monitoring can be valuable for personalizing critical-care interventions. We hypothesized that patients with AMI-CS experiencing persistent congestion measures during the first 24 hours of the PAC installment would exhibit worse in-hospital survival rates. We studied 295 patients with AMI-CS between January 2006 and December 2021. The first 24-hour PAC-derived hemodynamic measures were divided by the congestion profiling and the proposed 2022 Cardiovascular Angiography and Interventions (SCAI) classification. Biventricular congestion was the most common profile and was associated with the highest patient mortality rates at all time points (mean 56.6%). A persistent congestive profile was associated with increased mortality rates (hazard ratio [HR] = 1.85; P = 0.002) compared with patients who achieved decongestive profiles. Patients with SCAI stages D/E had higher levels of right atrial pressure (RAP): 14–15 mmHg) and pulmonary capillary wedge pressure (PCWP): 18–20 mmHg) compared with stage C (RAP, 10–11 mmHg, mean difference 3–5 mmHg; P < 0.001; PCWP 14–17 mmHg; mean difference 1.56–4 mmHg; P = 0.011). In SCAI stages D/E, the pulmonary artery pulsatility index (0.8–1.19) was lower than in those with grade C (1.29–1.63; mean difference 0.21–0.73; P < 0.001). Continuous congestion profiling using the SCAI classification matched the grade of hemodynamic severity and the increased risk of in-hospital death. Early decongestion appears to be an important prognostic and therapeutic goal in patients with AMI-CS and warrants further study. [Display omitted]