Effect of Invasive Hemodynamic Monitoring on the Outcomes of Cardiogenic Shock in Patients With Acute Myocardial Infarction

Abstract

The role of invasive hemodynamic monitoring on the outcomes of cardiogenic shock in patients with acute myocardial infarction (AMI-CS) is controversial. We evaluated whether invasive hemodynamic monitoring improved in-hospital mortality in patients with AMI-CS. This study analyzed 1513 patients with AMI-CS presenting between 2020 and 2022. Patients were classified into 2 groups on the basis of invasive monitoring. Patients receiving invasive hemodynamic monitoring (n = 602) were more likely to present with advanced cardiogenic shock stages, cardiac arrest, bradyarrhythmias, and required more mechanical ventilation and renal support. Propensity score identified 488 matched pairs. Escalation of mechanical support was greater in patients who received noninvasive monitoring (14% vs 7%; P < .001). There was no difference in mortality among the matched patients (49.0% vs 49.182%, P > .99). Hospital stay was longer in patients who received invasive monitoring (median 7 vs 6 days; P = .016). In patients receiving invasive monitoring, the cardiac index, pulmonary artery capillary wedge pressure, and right atrial pressure and the use of Swan-Ganz did not predict mortality. In AMI-CS, invasive hemodynamic monitoring was not associated with improved outcomes compared with routine monitoring. These findings highlight the inconsistent evidence surrounding monitoring methods, underscoring the need for further research to inform clinical decision-making.