Pulmonary artery catheterization in patients with acute coronary syndromes.
BACKGROUND
There are limited recent data evaluating the use of the pulmonary artery catheter (PAC) in patients hospitalized with an acute coronary syndrome (ACS). Using data from the multinational Global Registry of Acute Coronary Events, we examined trends in PAC use among patients hospitalized for an ACS and the association between PAC and hospital outcomes.


METHODS
Trends in PAC utilization between 2000 and 2007 were examined through the review of data contained in hospital medical records. We identified factors associated with PAC utilization and compared differences in the length of hospitalization and in-hospital death rates between patients undergoing PAC during the index hospitalization (PAC+, n = 2,879) and those managed without PAC (PAC-, n = 56,091).


RESULTS
The utilization of PAC during hospitalization for an ACS declined over time such that 3.0% of patients underwent PAC in 2007 compared with 5.4% in 2000. Admission Killip classification was the strongest factor associated with PAC insertion. The duration of hospitalization was significantly longer among PAC+ (median = 10.0 days) as compared with PAC- patients (median = 5.0 days). In-hospital death rates were significantly higher among PAC+ patients after adjustment for differences in baseline characteristics (odds ratio 4.00, 95% CI 3.41-4.70).


CONCLUSIONS
The frequency of PAC utilization in "real-world" patients hospitalized with ACS has declined during recent years. Our finding of increased in-hospital mortality among patients undergoing PAC is consistent with prior studies and may further challenge the efficacy of PAC in the setting of ACS.
Ruisi
Christopher P
CP
Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Goldberg
Robert J
RJ
Kennelly
Brian M
BM
Goodman
Shaun G
SG
Lopez-Sendon
Jose
J
Granger
Christopher B
CB
Avezum
Alvaro
A
Eagle
Kim A
KA
FitzGerald
Gordon
G
Gore
Joel M
JM
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries