D-25 | Cangrelor Use in Cardiogenic Shock - Findings from the CAMEO Registry

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Background: Understanding the role of right heart catheterization (RHC) in patients with cardiogenic shock during sepsis or septic shock is crucial, yet under-researched.This study aims to examine the impact of RHC on clinical outcomes in patients with multifactorial shock.Methods: A retrospective study using the National Inpatient Sample (2016-2020) identified adults hospitalized with sepsis or septic shock who had concurrent cardiogenic shock and were stratified based on the utilization of RHC.The primary outcome was in-hospital mortality.Secondary outcomes included length of stay, total costs, and in-hospital complications.Multivariate regression was used to adjust for baseline characteristics and comorbidities.Results: The study encompassed 121,560 patients admitted for sepsis or septic shock with concurrent cardiogenic shock, among whom 7.2% underwent RHC.Our findings revealed a significant reduction in inhospital mortality among patients who received RHC (31.7% vs. 47.2%;Adjusted Odds Ratio [AOR] 0.54; p<0.001).Additionally, RHC was associated with a decreased incidence of cardiac arrest (AOR 0.69; p<0.001).Conversely, RHC correlated with heightened risks of requiring mechanical circulatory support (AOR 7.4; p<0.001), cardioversion (AOR 1.90; p<0.001), and pacemaker or defibrillator placement (AOR 2.29; p<0.001).Notably, risks of stroke (AOR 1.38; p¼0.003), acute kidney injury (AOR 1.17; p¼0.02), and respiratory failure requiring intubation (AOR 1.13; p¼0.03) were higher in the RHC group.These patients also experienced longer hospital stays (Incidence Rate Ratio [IRR] 1.43; p<0.001) and higher hospital costs (IRR 1.58; p<0.001).A declining trend in RHC utilization was observed, decreasing from 7.8% in 2016 to 6.5% in 2020 (p-trend <0.001).Conclusions: In sepsis-induced cardiogenic shock, RHC use is associated with lower in-hospital mortality, despite its likely use in sicker cohorts as evidenced by the increased complications and longer hospital stays.The declining use of RHC highlights the importance of careful patient selection in this vulnerable patient group.

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