Chest

Chest

Volume 92, Issue 4, October 1987, Pages 721-727
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Clinical Dialogue
A Community-Wide Assessment of the Use of Pulmonary Artery Catheters in Patients with Acute Myocardial Infarction

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As part of an on-going population-based study of patients hospitalized with acute myocardial infarction (MI) in all 16 hospitals in the Worcester, Massachusetts Standard Metropolitan Statistical Area, temporal trends in the use of the pulmonary artery (PA) catheter were examined. Three thousand two hundred and sixty-three patients with validated acute MI during the calendar years 1975, 1978, 1981 and 1984 comprised the study population. There has been a consistent and significant increase in PA catheter use in patients with acute MI over time, from 7.2 percent in 1975, 13.8 percent in 1978, 14.8 percent in 1981 to 19.9 percent in 1984 (p<.001). Ninety-six percent of patients undergoing PA catheter investigation had either congestive heart failure (CHF), hypotension or cardiogenic shock. For the combined time periods, the in-hospital case fatality rate (CFR) for patients in CHF with a PA catheter was 44.8 percent compared to 25.3 percent for patients without a PA catheter (p<.001). For patients with hypotension and a PA catheter, in-hospital CFR was 48.3 percent compared to 32.2 percent for hypotensive patients not receiving a PA catheter (p<.001). In contrast, for patients in cardiogenic shock the in-hospital CFR was 74.4 percent for those receiving a PA catheter as compared to 79.1 percent for patients in shock not receiving a catheter. The use of a PA catheter was associated with an increased length of hospital stay irrespective of the development of acute clinical complications. Long-term prognosis for discharged hospital survivors who had a complicated MI, for up to a five-year follow-up period was similar whether the patient did or did not receive a PA catheter during the acute period of hospitalization. In conclusion, we could not demonstrate a beneficial effect associated with the use of the PA catheter on selected patient outcomes, including in-hospital and long-term prognosis and average hospital stay, in this community-wide study of patients hospitalized with acute MI.

Section snippets

MATERIALS AND METHODS

The population under study consists of patients hospitalized at all 16 general hospitals in the Worcester Standard Metropolitan Statistical Area (SMSA) (population—373,000, 1980 US census) with a primary or secondary discharge diagnosis of acute MI.13 A complete sampling of the International Classification of Disease (ICD) code 410 for acute MI (9th revision) is carried out. The diagnosis of acute MI is based on pre-defined criteria13, 12, 13, 14, 15 including clinical history, serial

Temporal Trends in PA Catheter Utilization

Hemodynamic monitoring with a PA catheter increased progressively and significantly over time. PA catheters were used in 7.2 percent of MI patients hospitalized in 1975, 13.8 percent in 1978, 14.8 percent in 1981, and 19.9 percent of patients in 1984 (Table 1) (p<.001).

The relationship between teaching (defined as hospitals with full-time house staff) and nonteaching hospitals, peak CK findings, extent of MI and MI location, and the use of the PA catheter was also examined (Table 1). In each

DISCUSSION

The results of this community-wide study demonstrated that usage of pulmonary artery catheterization in patients hospitalized with validated acute myocardial infarction in all 16 hospitals in the Worcester, Massachusetts SMSA increased almost three-fold between 1975 and 1984. In addition, the increasing use of the PA catheter was observed in each of the various subgroups examined, including those patients developing specific complications of acute MI in whom PA catheter use might be

ACKNOWLEDGMENT

The authors wish to express their appreciation to the administration, medical record departments, and cardiology departments of the hospitals in the Worcester SMSA who provided access to their medical records; to Sandra Knowlton and Gerrie Nespoli for data abstraction; to Donald Love and Marc Zive for statistical analysis; and to Mary Larson for secretarial assistance.

REFERENCES (28)

  • PD Goldenheim et al.

    Cardiopulmonary monitoring of critically ill patients (part II)

    N Engl J Med

    (1984)
  • HJC Swan et al.

    Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter

    N Engl J Med

    (1970)
  • IP Murray

    Complications of invasive monitoring

    Med Instrum

    (1981)
  • KD Boyd et al.

    A prospective study of complications of pulmonary artery catheterization in 500 consecutive patients

    Chest

    (1983)

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    Copyright © 1987 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.