Despite the extensive use of PAC in patients with AMI, controversy continues to exist as to whether or not such use contributes to improvement in mortality, or possibly even increases mortality. No randomized trials have been performed, nor would the development of such trials in the future be feasible. An attempt to resolve the controversy by analysis of data from large numbers of patients treated for myocardial infarction, and comparing outcome, was made by Gore et al. The authors conceded that the study suffered from the weakness that data were obtained retrospectively. flovent inhaler
However, a multivariate analysis adjusting for other factors known to increase risk revealed a significantly increased mortality associated with the use of PAC. The increased mortality was found in each of the three categories of patients comprising the “pump failure” group (CHF, hypotension, cardiogenic shock). The authors did not attempt to further classify CHF into gradations of severity and were unable to determine if patients receiving PAC were, indeed, sicker than those who did not. They could not, therefore, exclude the possibility that the increased mortality associated with the use of PAC could be due to greater severity of hemodynamic disturbance in patients receiving PAC.