PACCS Trial
Details
PACCS is an ongoing randomised trial testing early pulmonary artery catheterisation within 6 hours of randomisation in heart-failure-related cardiogenic shock (HF-CS). It is designed to settle a question that current practice answers from observational data: whether routine invasive haemodynamic monitoring improves outcomes in shock. (sources/cardiogenic-shock-acc-2025, rating: very high)
Key Facts
- Ongoing; randomised; HF-CS population. (sources/cardiogenic-shock-acc-2025, rating: very high)
- Intervention: pulmonary artery catheter (PAC) placed within 6 hours of randomisation. (sources/cardiogenic-shock-acc-2025, rating: very high)
- Current guidance on PAC use in shock rests on retrospective and registry data, not randomised evidence, and the ACC 2025 guidance explicitly notes that the trial results are pending. (sources/cardiogenic-shock-acc-2025, rating: very high)
- The question matters because PAC-derived data underpin phenotyping and congestion profiling, including PAPi and the choice of escalation strategy. (sources/cardiogenic-shock-acc-2025, rating: very high)
Contradictions / Open Questions
- No randomised evidence yet determines whether PAC use improves outcomes in cardiogenic shock; observational associations with benefit may reflect selection of sicker patients who are monitored and treated more aggressively. (sources/cardiogenic-shock-acc-2025, rating: very high)
- HF-CS is the intended population, whereas most positive and negative shock trials enrolled AMI-CS — so the result may not transfer to the AMI-CS phenotype. (sources/cardiogenic-shock-acc-2025, rating: very high)
Connections
- Related to concepts/Cardiogenic-Shock — diagnosis, phenotyping and SCAI staging
- Related to concepts/Cardiogenic-Shock — PAC use, congestion profiles and PAPi
- Related to concepts/Cardiogenic-Shock — monitoring guides device escalation