Use of Pulmonary Artery Catheters in Patients with Acute Myocardial Infarction
The use of flow-directed PAC in patients admitted to the hospital with AMI was introduced in 1970. The wide acceptance of this technique for assistance in diagnosis and management of patients with AMI subsequently was questioned by some observers. In a review of ten years of experience with PAC for monitoring purposes, Swan and Ganz in 1983 wrote “… elaborate randomized trials to ‘prove’ effectiveness are impractical and would probably fail to provide the desired guidelines even if brought to completion.” Nevertheless, Gore et al in 1987 expressed the opinion that “a randomized controlled clinical trial to assess the efficacy of the PA catheter in patients with acute myocardial infarction is indicated.” This opinion was based on the results of their analysis of the use of thiscatheter in 3,263 patients in 16 general hospitals. While the authors conceded that pulmonary artery catheterization may be helpful in selected patients, their study failed to provide evidence of positive therapeutic benefit in the management of patients with AMI complicated by CHF, hypotension or cardiogenic shock.
Using multivariate analysis techniques to adjust for differences in additional prognostic factors, the authors showed that a significantly increased in-hospital mortality continued to persist for patients with CHF, hypotension and in those with or without a complicated AMI, who received PAC compared to similar patients not receiving PAC. In an editorial based on these findings, the author, while conceding that multivariate analysis of uncontrolled, retrospectively obtained data might have overlooked the fact that the catheter was used in more gravely ill patients, nevertheless felt that the use of the catheter may have added to the risk of the patient. He proposed a moratorium on the use of the catheter until results of an appropriately designed randomized trial were available. canadian family pharmacy
The purpose of the present study was to analyze retrospectively the usage of PAC and the mortality of patients receiving, as compared to those not receiving, such catheters in a series of 5,841 patients with AMI.