subject of attention objective: To examine changes athwart time in the utilization of and factors associated with pulmonary artery (PA) catheterization in patients hospitalized with acute myocardial infarction (AMI).

Design: Nonconcurrent prospective investigation carried out in 16 teaching and community hospitals in Worcester, Mass, in seven time periods between 1975 and 1990 A total of 5480 patients hospitalized with validated AMI comprised the application of mind sample.

Results: Use of PA catheterization increased from 1975 to 1984 with a consistent decline thereafter in all patients with AMI studied. Among the 2441 patients with complicated AMI, use of PA catheterization increased from 1975 from one side 1988 with a decline in use in 1990 For the combined meditation periods, 14.7 percent of all patients with AMI studied and 254 percent of those with complicated AMI underwent PA catheterization. After adjusting for other potentially confounding factors by the and of use of a logistic regression analysis, younger patients, those with a history of angina, those with Q-wave AMI, those who died, and those patients developing congestive heart failure or cardiogenic collision during the acute hospitalization were significantly more likely to be exposed to PA catheterization than respective comparison arranges among all patients with AMI studied. Younger age, proceeding of Q-wave AMI, and having died during the short-term hospitalization were associated with receipt of PA catheterization in patients with complicated AMI.

Conclusions: The conclusions of this multihospital, community-based contemplation provide insight into changes across time in the use of PA catheterization and patient-related factors associated with receipt of PA catheterization in the setting of AMI.

The care of patients with acute myocardial infarction (AMI) has undergone significant change throughout the past several decades, in part befitting to the introduction and use of bedside hemodynamic monitoring. The flow-directed pulmonary artery (PA) catheter was introduced according to Swan and associates[1] in 1970 and has been widely used in scores of critically ill patients since that time. It has been estimated that approximately 100000 patients with AMI be exposed to PA catheterization annually in the United States.[2] Use of the PA catheter provides hemodynamic information that may be of benefit in selecting therapeutic options and monitoring consequences in patients with various complications of AMI. Furthermore, PA catheterization provides data that can be utilized to stratify patients at differential risk of dying during the short-term hospitalization. Despite its widespread use, however, latter controversy[3,4] has surrounded the PA catheter because a lack of benefit onward selected outcomes has been demonstrated in couple large nonrandomized population-based studies of patients hospitalized with AMI.[5,6] While PA catheterization is typically engrossed in patients with AMI complicated through left ventricular failure, limited data exist, particularly from a multihospital community-wide perspective, of patient-related factors associated with PA catheterization. Using data from an ongoing population-based studious mood of patients hospitalized with AMI in 16 hospitals in the Worcester, Mass, Standard Metropolitan Statistical Area,[7-9] we examined the sociodemographic and clinical characteristics of patients with AMI receiving PA catheters in order to provide a profile of patients who suffer this invasive procedure. In addition, we examined changes through time (1975 to 1990) in the utilization of PA catheterization.

MATERIALS AND METHODS

The Worcester Heart Attack thought is an ongoing community-wide meditation examining time trends in the incidence rates as well as in-hospital and long-term case-fatality rates of patients hospitalized with AMI in 16 general hospitals in the Worcester, Mass, Standard Metropolitan Statistical Area (1980 census population = 373000) during calendar years 1975 1978 1981 1984 1986 1988 and 1990

The medical records of all patients with a primary or secondary hospital discharge diagnosis of AMI (Ninth International Classification of Disease collection of lawss 410 and 411) from participating hospitals were individually reviewed and validated according to predefined diagnostic criteria that have been described previously.[7-9] In brief, these criteria included satisfaction of at least sum of two units of the following three factors: clinical history, serum enzyme flat elevations, and serial electrocardiographic findings. The transaction of selected complications during hospitalization for AMI was assessed upon the basis of information available from the clinical charts. Congestive heart failure was regarded as not past nor future when there was evidence of pulmonary edema or bilateral basilar rales with an S3 gallop. Cardiogenic conflict was considered present when the systolic kin pressure was less than 80 mm Hg in the absence of hypovolemia and associated with cyanosis, polar extremities, changes in mental status, and persistent oliguria.[9] The definition of these complications remained the same through the periods under study and were defined in the way that that patients with classic signs and symptoms of these complications would be included. In addition, all autopsy-proved cases of AMI were included irrespective of the other criteria.

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