Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness

摘要: Context Pulmonary artery catheters (PACs) have been used to guide therapy in multiple settings, but recent studies raised concerns that PACs may lead increased mortality hospitalized patients. Objective To determine whether PAC use is safe and improves clinical outcomes patients with severe symptomatic recurrent heart failure. Design, setting, participants The Evaluation Study of Congestive Heart Failure Artery Catheterization Effectiveness (ESCAPE) was a randomized controlled trial 433 at 26 sites conducted from January 18, 2000, November 17, 2003. Patients were assigned receive guided by assessment or alone. target both groups resolution congestion, additional targets pulmonary capillary wedge pressure 15 mm Hg right atrial 8 Hg. Medications not specified, inotrope explicitly discouraged. Main outcome measures primary end point days alive out the hospital during first 6 months, secondary points exercise, quality life, biochemical, echocardiographic changes. Results Severity illness reflected following values: average left ventricular ejection fraction, 19%; systolic blood pressure, 106 Hg; sodium level, 137 mEq/L; urea nitrogen, 35 mg/dL (12.40 mmol/L); creatinine, 1.5 (132.6 micromol/L). Therapy led substantial reduction symptoms, jugular venous edema. Use did significantly affect months (133 vs 135 days; hazard ratio [HR], 1.00 [95% confidence interval {CI}, 0.82-1.21]; P = .99), (43 [10%] 38 [9%]; odds [OR], 1.26 CI, 0.78-2.03]; .35), number (8.7 8.3; HR, 1.04 0.86-1.27]; .67). In-hospital adverse events more common among group (47 [21.9%] 25 [11.5%]; .04). There no deaths related use, difference for in-hospital plus 30-day (10 [4.7%] 11 [5.0%]; OR, 0.97 0.38-2.22]; .97). Exercise life improved trend toward greater improvement PAC, which reached significance time trade-off all after randomization. Conclusions reduce volume overload hospitalization failure marked signs symptoms elevated filling pressures without PAC. Addition careful anticipated events, overall hospitalization. Future trials should test noninvasive assessments specific treatment strategies could be better tailor survival as valued