(1065) Pulmonary Artery Catheterization in Heart Failure With Ischemic STEMIs: National Subgroup Analysis

Introduction: Cardiogenic shock (CS) is a severe condition marked by low cardiac output and multiorgan failure, often necessitating urgent intervention. Pulmonary Artery Catheterization (PAC) is frequently used to guide therapy in acute hemodynamic decompensation, yet its efficacy in patients with heart failure and concurrent ischemia remains uncertain. This study aims to assess the impact of PAC utilization on clinical outcomes in these patients, including mortality, length of stay (LOS), costs, and complications. Additionally, it explores outcomes in subgroups with and without cardiogenic shock and those using various mechanical circulatory support devices.

Methods: This retrospective cohort study used the 2020 National Inpatient Sample (NIS), the largest all-payer inpatient database in the U.S., representing nonfederal acute-care hospitals. We included patients aged 18+ with congestive heart failure and myocardial infarction, identified by ICD-10 codes. Patients with PAC, including Swan-Ganz catheter placement, were also identified. Statistical analysis included chi-square and Wilcoxon rank sum tests for baseline characteristics, and multivariate regression for outcome associations. Outcomes assessed were in-hospital mortality, length of stay, cardiac arrest, mechanical circulatory support, and hospital costs.

Results: The dataset comprised 114,647 individuals with a mean age of 70.66 years. Mortality was observed in 11.47% of patients. Logistic regression analysis showed an odds ratio for mortality associated with RHC utilization of 0.82 (95% CI: 0.76 – 0.89, p < 0.001). Each RHC instance correlated with a significant increase in hospitalization costs ($20,150.37, p < 0.001) and length of stay by 2.1 days (p < 0.001).

Conclusions: PAC utilization is associated with reduced mortality rates in heart failure patients with ischemia but also leads to higher costs and longer hospital stays. These findings suggest that while PAC can be beneficial, especially when precise physiological data is crucial, it also comes with significant financial and logistical considerations.