Use of Pulmonary Artery Catheters in Patients with Acute Myocardial Infarction: Discussion (2)
The present study also showed an increased hospital mortality in patients receiving PAC, with an odds ratio on multivariate analysis of 2.98. In the patients classed as being in “pump failure,” the increased mortality was confined to those with CHF and was not present in patients with cardiogenic shock or persistent hypotension. Clinical experience suggested that, in fact, PAC would be introduced more frequently in the patients with more severe degrees of CHF, in whom a higher mortality would be expected. We tested this belief by reviewing hospital discharge summaries of the 118 patients, receiving PAC, who were admitted with CHF or developed it during their stay in hospital but did not have cardiogenic shock or hypotension persisting more than 48 h. Patients were classified as suffering from either mild, moderate or severe CHF. buy cipro
A similar review was made of 246 age- and sex-matched patients with CHF who did not receive PAC. This sample of patients (>10 percent) was randomly selected from the computer and is regarded as representative of the total group of patients with CHF who did not receive PAC. While acknowledging the deficiencies of such a retrospective review, we nevertheless found evidence to suggest that, indeed, PAC was used more frequently in patients with more severe degrees of CHF. Moreover, when comparing patients who received PAC with those who did not and determining in-hospital mortality according to severity of CHF, no differences were found for patients with mild to moderate CHF.