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

Publication ,  Journal Article
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
Published in: Am J Med
May 2005

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 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.

Duke Scholars

Published In

Am J Med

DOI

ISSN

0002-9343

Publication Date

May 2005

Volume

118

Issue

5

Start / End Page

482 / 488

Location

United States

Related Subject Headings

  • Survival Rate
  • Risk Adjustment
  • Retrospective Studies
  • Proportional Hazards Models
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cohen, M. G., Kelly, R. V., Kong, D. F., Menon, V., Shah, M., Ferreira, J., … Granger, C. B. (2005). Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials. Am J Med, 118(5), 482–488. https://doi.org/10.1016/j.amjmed.2004.12.018
Cohen, Mauricio G., Robert V. Kelly, David F. Kong, Venu Menon, Monica Shah, Jorge Ferreira, Karen S. Pieper, et al. “Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials.Am J Med 118, no. 5 (May 2005): 482–88. https://doi.org/10.1016/j.amjmed.2004.12.018.
Cohen MG, Kelly RV, Kong DF, Menon V, Shah M, Ferreira J, et al. Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials. Am J Med. 2005 May;118(5):482–8.
Cohen, Mauricio G., et al. “Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials.Am J Med, vol. 118, no. 5, May 2005, pp. 482–88. Pubmed, doi:10.1016/j.amjmed.2004.12.018.
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. Pulmonary artery catheterization in acute coronary syndromes: insights from the GUSTO IIb and GUSTO III trials. Am J Med. 2005 May;118(5):482–488.
Journal cover image

Published In

Am J Med

DOI

ISSN

0002-9343

Publication Date

May 2005

Volume

118

Issue

5

Start / End Page

482 / 488

Location

United States

Related Subject Headings

  • Survival Rate
  • Risk Adjustment
  • Retrospective Studies
  • Proportional Hazards Models
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female