Abstract 16279: Diagnosis of Cardiogenic Shock Without the Use of a Pulmonary Artery Catheter
Background: The diagnosis of cardiogenic shock (CS) traditionally requires invasive hemodynamic assessment with pulmonary artery catheterization (PAC). We developed and validated a set of noninvasive diagnostic criteria for CS consisting solely of simple clinical, laboratory, and echocardiographic variables.
Methods: Candidate variables were examined in a retrospective development cohort of 122 consecutive patients with acute myocardial infarction (AMI) who underwent both PAC and echocardiography in a 24 hour period. Using traditional invasive criteria (cardiac index≤2.2L/min/m2, wedge pressure≥15mmHg, systolic blood pressure<90mmHg or requiring support, and urine output<30mL/hour) as the gold standard, the noninvasive criteria were optimized by assessing various combinations of the candidate variables. The final noninvasive criteria (Table) were then tested in a separate validation cohort of 217 consecutive coronary care unit patients in whom PAC, laboratory, and echocardiographic data were obtained simultaneously.
Results: In the validation cohort, sensitivity, specificity, positive and negative likelihood ratios of the noninvasive criteria were: 97%, 91%, 10.5, and 0.3. In a subgroup of patients with AMI (n=77) these were 93%, 82%, 5.3, and 0.08 respectively. Using these criteria, patients identified as having CS had a lower cardiac index (1.8±0.6 vs. 2.6±0.8 L/min/m2, P<0.0001), a higher wedge pressure (21.9±5.9 vs. 18.5±7.2 mmHg, P<0.001), and a higher in-hospital mortality rate (46% vs. 17%, P<0.001) than those without CS.
Conclusion: CS can be accurately diagnosed without PAC using easily obtained clinical, laboratory, and echocardiographic data points. Validation in other critical care settings is required.
- © 2013 by American Heart Association, Inc.