Pulmonary artery catheterization in acute coronary syndromes: Insights from the GUSTO IIb and GUSTO III trials

Mauricio G Cohen, Robert V. Kelly, David F. Kong, Venu Menon, Monica Shah, Jorge Ferreira, Karen S. Pieper, Douglas Criger, Rosana Poggio, E. Magnus Ohman, Joel Gore, Robert M. Califf, Christopher B. Granger

Research output: Contribution to journalArticle

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Abstract

PURPOSE: 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). SUBJECTS AND METHODS: We retrospectively studied 26 437 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.

Original languageEnglish
Pages (from-to)482-488
Number of pages7
JournalAmerican Journal of Medicine
Volume118
Issue number5
DOIs
StatePublished - May 1 2005
Externally publishedYes

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Swan-Ganz Catheterization
Acute Coronary Syndrome
Cardiogenic Shock
Odds Ratio
Confidence Intervals
Intratracheal Intubation
Mortality
Coronary Artery Bypass
Pulmonary Artery

Keywords

  • Acute coronary syndrome
  • GUSTO IIb
  • GUSTO III
  • Pulmonary artery catheterization

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Pulmonary artery catheterization in acute coronary syndromes : Insights from the GUSTO IIb and GUSTO III trials. / Cohen, Mauricio G; Kelly, Robert V.; Kong, David F.; Menon, Venu; Shah, Monica; Ferreira, Jorge; Pieper, Karen S.; Criger, Douglas; Poggio, Rosana; Ohman, E. Magnus; Gore, Joel; Califf, Robert M.; Granger, Christopher B.

In: American Journal of Medicine, Vol. 118, No. 5, 01.05.2005, p. 482-488.

Research output: Contribution to journalArticle

Cohen, MG, Kelly, RV, Kong, DF, Menon, V, Shah, M, Ferreira, J, Pieper, KS, Criger, D, Poggio, R, Ohman, EM, Gore, J, Califf, RM & Granger, CB 2005, 'Pulmonary artery catheterization in acute coronary syndromes: Insights from the GUSTO IIb and GUSTO III trials', American Journal of Medicine, vol. 118, no. 5, pp. 482-488. https://doi.org/10.1016/j.amjmed.2004.12.018
Cohen, Mauricio G ; Kelly, Robert V. ; Kong, David F. ; Menon, Venu ; Shah, Monica ; Ferreira, Jorge ; Pieper, Karen S. ; Criger, Douglas ; Poggio, Rosana ; Ohman, E. Magnus ; Gore, Joel ; Califf, Robert M. ; Granger, Christopher B. / Pulmonary artery catheterization in acute coronary syndromes : Insights from the GUSTO IIb and GUSTO III trials. In: American Journal of Medicine. 2005 ; Vol. 118, No. 5. pp. 482-488.
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abstract = "PURPOSE: 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). SUBJECTS AND METHODS: We retrospectively studied 26 437 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.",
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AU - Shah, Monica

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N2 - PURPOSE: 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). SUBJECTS AND METHODS: We retrospectively studied 26 437 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.

AB - PURPOSE: 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). SUBJECTS AND METHODS: We retrospectively studied 26 437 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.

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