Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials.
OBJECTIVE
To correlate pulmonary artery catheterization (PAC) use and 30-day outcomes and to characterize the use of pulmonary artery catheters among patients with acute coronary syndromes (ACS).


METHODS
We retrospectively studied 26437 ACS patients from two large multicenter, international randomized clinical trials. Multivariable and causal inference analyses were applied to adjust for differences in baseline risk.


RESULTS
PAC was performed in 735 patients (2.8%), with a median time to insertion of 24 hours. Patients undergoing PAC were older (median, 67 vs. 64 years), more often diabetic (25.7% vs.16.2%), and more likely to present with ST-segment elevation (81.6% vs. 70.2%) or Killip class III or IV (7.9% vs. 1.4%). US patients were 3.8 times more likely than non-US patients to undergo PAC. Patients managed with PAC also underwent more procedures, including percutaneous intervention (40.7% vs. 18.1%), coronary artery bypass grafting (12.5% vs. 7.7%), and endotracheal intubation (29.3% vs. 2.2%). Mortality at 30 days was substantially higher among patients with PAC for both unadjusted (odds ratio [OR] 8.7; 95% confidence interval [CI] 7.3-10.2) and adjusted analyses (OR 6.4; 95% CI 5.4-7.6) in all groups except in patients with cardiogenic shock (OR 0.99; 95% CI 0.80-1.23).


CONCLUSIONS
PAC was associated with increased mortality, both before and after adjustment for baseline patient differences and subsequent events that may have led to PAC use, except in patients with cardiogenic shock. The definitive role of PAC in managing patients with ACS is still to be determined.
Cohen
Mauricio G
MG
Division of Cardiology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, CB #7075, Bioinformatics Building Suite 4128, Chapel Hill, NC 27599, USA. mgcohen@med.unc.edu
Kelly
Robert V
RV
Kong
David F
DF
Menon
Venu
V
Shah
Monica
M
Ferreira
Jorge
J
Pieper
Karen S
KS
Criger
Douglas
D
Poggio
Rosana
R
Ohman
E Magnus
EM
Gore
Joel
J
Califf
Robert M
RM
Granger
Christopher B
CB
D000208:Acute Disease; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects*; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020379:Risk Adjustment; D015996:Survival Rate