Time from Admission to Right Heart Catheterization in Cardiogenic Shock Patients

Cardiogenic shock (CS) presents with a complex spectrum of low output states, which can be provoked by Acute Coronary Syndrome (ACS) or Acute Decompensated Heart Failure (ADHF). Its man-agement includes hemodynamic assessment via right heart catheterization (RHC). Herein, we describe the timing of RHC based on the etiology and severity of CS as defined by the Society of Cardiovascular Angi-ography & Interventions (SCAI) Shock Classification. We performed a single-center retrospective analysis of patients admitted with CS secondary to ACS or ADHF from January 7, 2018 to June 30, 2020 at the Univer-sity of Iowa Hospitals and Clinics. Among the 647 patients admitted, 249 patients had RHC during their admission. Of those, 51 had underlying ACS and 198 had ADHF. The overall time from admission to inva-sive hemodynamic assessment was 2.73 days. The mean time for SCAI-A was 3.6 & PLUSMN; 2.8 days, SCAI-B 3.7 & PLUSMN; 3.7 days, SCAI-C 2.6 & PLUSMN; 3.0 days, SCAI-D 2.5 & PLUSMN; 4.1 days, and SCAI-E 1.3 & PLUSMN; 2.1 days. The linear regression model showed that RHC was performed earlier in patients with worse hemodynamics evaluated by Cardiac Power Output (CPO) (Coefficient 0.14, R -squared 0.01, P = 0.03). Hemodynamic parameters showed that high PAPi, RVSWi, and Cardiac Power Output during admission predicted low in-hospital mortality (P < 0.01). RHC was performed earlier in more critically ill patients. Patients with CS in the setting of ACS underwent RHC significantly earlier than those with ADHF. (Curr Probl Cardiol 2023;48:101441.)

Automated summary

This study retrospectively analyzed the management of patients with cardiogenic shock caused by ACS or ADHF, including the timing of hemodynamic assessment via RHC. The results showed that RHC was performed earlier in patients with more severe cardiac dysfunction, and patients with ACS underwent RHC significantly earlier than those with ADHF.