Abstract 4369474: Right Heart Catheterization in Patients with Cardiogenic Shock: A Worldwide Retrospective Cohort Study.

Abstract

Introduction/Aims: Despite initial popularity, the usefulness of right heart catheterization (RHC) is long debated, with cardiogenic shock (CS) patients largely overlooked until recent studies. Previous studies have failed to demonstrate a direct mortality benefit of RHC, instead showing improved outcomes only when including RHC in composite endpoints. A study directly investigating mortality benefit associated with RHC use in CS patients has yet to be conducted. Goals/Aims: This study aims to provide a more comprehensive analysis of long-term mortality benefit in CS patients from RHC use through the global network TriNetX which offers a large, diverse patient cohort and leverages recent advancements in data analytics and clinical management. Methods: This retrospective cohort study used data from 144 healthcare organizations (HCOs) within the Global Health Research Collaborative Network TriNetX, identifying 220,737 CS patients who did not undergo right heart catheterization (control group) and 48,785 patients who underwent RHC (RHC group). Kaplan–Meier plots and log-rank tests were calculated with outcomes analyzed at 30-days, 6-months, and 12-months all-cause death mortality from propensity matched cohorts. Results: After propensity score matching, 47,260 patients were analyzed per group. The RHC group showed a significant all-cause death rate decrease with 13.1% difference at 30-days (HR 0.54, 95% CI 0.527–0.557, p<0.0001), 1.92% difference at 6-months (HR 0.80, 95% CI 0.768–0.837, p=<0.0001). A nonsignificant 0.45% difference was found at 12-month follow-up (HR 0.84, 95% CI 0.780-0.897, p=0.9155). Conclusions: This retrospective cohort study included a large global cohort of CS patients and directly demonstrated an association of RHC with lower 30-day and 6-month all-cause mortality that converges between RHC and controls at 12 months as overall survival probability overshoots 90%. There is a notable increase in RHC group survivability at 12-month follow-up compared to controls showing longitudinal RHC mortality benefit and further supporting the use of RHC in CS patients. Still the overall mortality present in both groups at 12-month follow-up highlights survival limitations in cardiogenic shock patients and underscores the need to investigate underlying causes of this limited survival to develop strategies for improvement. Further evidence from randomized controlled trials is essential to confirm the potential benefits of RHC in this patient population.