Use of Pulmonary Artery Catheters in Patients with Acute Myocardial Infarction: Results (2)

Use of Pulmonary Artery Catheters in Patients with Acute Myocardial Infarction: Results (2)The higher in-hospital mortality of patients receiving PAC was present in every category of rhythm disturbance (Table 3). Table 4 shows that in patients with CHF, mortality was almost twice as high in those receiving PAC (59.4 vs 33.5 percent), while no significant difference was noted in patients with cardiogenic shock or persistent hypotension. However, a higher mortality was noted in patients receiving PAC, irrespective of the presence or absence of “pump failure” (Fig 2). buy ventolin inhalers
The indications for use of the catheter in patients not categorized as “pump failure” and their modes of death are shown in Table 5. It can be seen that five out of eight deaths in this group were due to rupture of the interventricular septum and two were due to progressive hypotension of less than 48 h duration.
A multivariate analysis of the factors associated with higher mortality showed that when allowance was made for cardiogenic shock, persistent hypotension, atrioventricular block, increased age, female sex, CHF and peak serum LDH above four times the upper limit of normal, the introduction of a PAC was associated with an adjusted odds ratio for in-hospital death of 2.98 but for one-year mortality of 1.04.

Table 3—Hospital Mortality According to Pulmonary Artery Catheter Insertion and Rhythm Disturbance in Coronary Care Unit

Mortality (%)
Receiving Not Receiving
Rhythm No. PAC PAC
Atrial fibrillation 764 61.7 23.9
A-V block 642 70.1 38.2
(grade 2 or 3)
Ventricular tachycardia 970 61.2 22.4
Ventricular fibrillation 400 74.5 52.4

Table 4—Hospital Mortality According to Pulmonary Artery Catheter Insertion and Hemodynamic Status

Mortality (%)
Hemodynamic Receiving Not Receiving
Complication No. PAC PAC
CHF 2,547 59.4 33.5
Cardiogenic shock 581 90.0 91.0
Persistent hypotension 184 60.9 63.5
(>48 h)

Table 5—Indications for Pulmonary Artery Catheter Insertion and Mortality in Patients without Pump Failure

Indication No. of Patients Death(No.)
Low blood pressure 5 2
Suspected pulmonary 1 0
embolism
Unexplained tachycardia 5 0
Suspected rupture, 5 5
ventricular septum
Right ventricular 3 0
infarction+oliguria
Recurrent or on-going 29 1
pain+beta-blocker therapy
Miscellaneous 4 0
Total 52 8

Figure-2

Figure 2. In-hospital mortality for patients receiving (PAC + ) and those not receiving (PAC—) PAC, related to the presence or absence of “pump Mure” (as defined in the “Materials and Methods” section).

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