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Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: Results

Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: ResultsTemporal Trends in PA Catheter Utilization
Use of the PA catheter in all patients with AMI studied increased from 1975 to 1984 with a consistent decline thereafter (Fig 1). In the 2,441 patients with complicated AMI in whom utilization rates of the PA catheter were between approximately one and one half to two times greater than in all patients with AMI studied, use of PA catheterization progressively increased from 1975 through 1988 with a decline in use in 1990 (Fig 1). Overall, 14.7 percent of all patients with AMI received a PA catheter during hospitalization while 25.4 percent of those with complicated AMI underwent PA catheterization. www.canadian-familypharmacy.com

Profile of Patients With AMI Undergoing PA Catheterization
In examining the univariate associations of a variety of patient-related characteristics with PA catheterization in the total study sample (Table 1), patients 65 to 84 years of age, those with a history of angina or hypertension, patients hospitalized in teaching institutions, those with an anterior, Q wave, complicated AMI, and those who died during hospitalization were significantly more likely to undergo PA catheterization than respective comparison groups (p<0.05). Among patients with complicated AMI, age, gender, type of hospital admission, development of Q-wave AMI, and hospital survival status were significantly associated with PA catheterization (p<0.05) (Table 2). Time trends in the utilization of PA catheterization according to selected patient characteristics are also shown separately in Tables 1 and 2 respectively for all patients and for those with complicated AML
Factors Associated With Receipt of PA Catheterization: Multivariate Analysis
Two logistic multiple regression analyses were carried out to examine factors significantly associated with use of PA catheterization separately in all hospitalized patients and in those with complicated AMI (Table 3). Results of this analysis showed that younger age, history of angina pectoris, Q-wave AMI, hospital survival status, and occurrence of congestive heart failure or cardiogenic shock during the short-term hospitalization were significantly associated with receipt of PA catheterization among all patients with AMI studied. History of angina, diagnosis of Q-wave AMI, and lack of survival throughout the short-term hospital stay were significantly associated with PA catheter use in patients with complicated AMI. Decreasing trends in the use of PA catheterization with advancing age were similarly observed in patients with complicated AMI.

Figure-1

Figure 1. Temporal trends in pulmonary artery catheterization in patients with acute myocardial infarction: The Worcester Heart Attack Study.

Table 1—Characteristics of Patients With Acute Myocardial Infarction (AMI) Who Received Pulmonary Artery Catheterization Overall and by Study Year

Characteristic All Periods Combined, % 1975, % 1978, % 1981, % 1984,% 1986, % 1988, % 1990, %
Age, yr
<55 13.5 10.8 13.5 17.0 18.9 15.9 11.2 8.2
55-64 13.7 7.5 12.9 13.4 24.5 17.6 13.8 6.7
65-74 17.0 8.1 17.5 18.9 17.2 23.1 21.3 12.1
75-84 16.4 5.4 13.6 14.9 24.3 22.8 20.9 15.9
854- 10.2 3.7 6.9 11.7 13.8 10.8 14.3 9.7
Sex
Male 14.5 6.8 13.8 16.5 21.1 17.5 15.4 10.4
Female 15.1 7.5 13.4 12.9 17.8 22.0 20.6 12.9
Medical history Angina pectoris
Present 17.0 8.9 15.0 15.1 28.4 20.1 18.6 15.0
Absent 13.9 6.5 13.2 15.1 16.9 19.1 17.0 9.9
Diabetes mellitus
Present 15.7 6.1 17.0 13.0 20.9 20.4 17.4 13.8
Absent 14.4 7.3 12.5 15.7 19.6 19.0 17.5 10.5
Hypertension
Present 16.0 6.9 15.3 16.4 19.3 19.4 19.7 14.2
Absent 13.5 7.2 12.3 14.0 20.6 19.3 15.3 8.2
Type of hospital of admission
Teaching 17.7 10.4 19.2 18.1 23.3 21.6 18.7 11.8
Nonteaching 7.9 1.5 7.9 11.8 12.8 13.9 10.8
AMI order
Initial 14.1 6.6 11.5 15.3 19.0 20.5 16.1 10.4
Recurrent 15.8 8.0 17.8 14.8 21.6 16.8 20.2 13.1
AMI type
Q-wave 17.9 8.0 17.4 19.8 24.6 24.6 18.7 14.4
Non Q-wave 10.6 5.0 7.5 9.4 12.8 13.4 16.4 8.6
AMI location
Anterior 16.4 8.0 15.9 17.4 20.1 19.9 18.6 15.3
Inferior/posterior 13.1 6.1 11.5 12.9 19.7 18.7 16.6 8.0
Complications
Congestive heart failure
Present 24.6 11.3 24.4 26.2 30.1 30.2 29.5 19.8
Absent 7.5 4.1 6.3 7.6 8.4 11.1 10.4 5.2
Cardiogenic shock
Present 57.5 29.8 43.3 61.3 75.0 63.8 66.7 67.6
Absent 11.4 5.3 11.3 11.4 15.9 15.7 12.5 8.5
Survival status
Live 10.3 5.7 9.3 10.3 15.0 15.1 10.4 6.5
Dead 35.1 12.0 31.1 36.2 46.4 41.1 50.0 39.7

Table 2—Characteristics of Patients With Complicated Acute Myocardial Infarction (AMI) Who Received Pulmonary Artery Catheterization Overall and by Study Year

Characteristic All Periods Combined, % 1975, % 1978, % 1981, % 1984, % 1986, % 1988, % 1990, %
Age, yr
<55 29.2 29.4 35.0 40.0 25.0 38.1 21.4 11.8
55-64 32.1 11.5 30.4 38.8 51.9 37.7 29.5 21.4
65-74 30.4 12.4 34.7 41.2 25.7 36.6 40.7 23.0
75-84 25.1 9.9 19.7 24.3 33.9 29.0 31.5 29.0
85+ 13.9 6.1 10.6 15.6 18.5 12.5 21.2 12.8
Sex
Male 27.4 10.7 27.7 32.3 33.6 31.9 30.6 22.8
Female 23.5 11.6 20.2 22.3 25.1 30.0 33.8 22.3
Medical history
Angina pectoris
Present 27.3 11.9 26.3 26.1 37.6 32.0 30.1 27.7
Absent 24.8 10.7 23.5 28.6 26.6 30.4 33.1 20.3
Diabetes mellitus
Present 23.8 9.6 28.2 19.7 28.4 29.0 27.8 21.7
Absent 26.3 11.6 22.5 30.9 30.6 31.7 34.1 22.9
Hypertension
Present 26.8 7.6 26.0 29.6 28.6 31.9 33.3 27.4
Absent 24.2 13.8 22.7 25.7 31.4 29.7 31.0 15.7
Type of hospital of admission
Teaching 28.1 14.2 29.7 31.6 32.5 33.9 31.8 20.7
Nonteaching 18.1 5.1 15.0 22.1 22.1 33.3 25.9
AMI order
Initial 26.6 11.0 21.3 31.3 32.1 33.5 31.7 22.8
Recurrent 24.2 11.3 28.7 23.5 27.1 26.9 33.0 22.3
AMI type
Q-wave 30.7 12.2 29.4 35.3 37.6 38.8 37.0 28.7
Non Q-wave 18.9 8.7 14.3 18.6 19.0 22.4 28.3 17.2
AMI location
Anterior 26.7 12.7 26.7 27.2 26.9 30.9 34.4 28.8
I nf er ior / posterior 24.2 9.4 21.9 28.4 34.4 30.9 30.1 16.0
Survival status
Live 19.0 9.0 19.5 20.1 23.3 25.7 20.0 12.3
Dead 40.8 14.6 33.3 44.1 51.1 45.6 56.2 52.6

Table 3—Factors Significantly Associated With Use of Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction (AMI)

Factors Total Sample Patients With Complicated AMI*
Adjusted Odds Ratio 95% Cl Adjusted Odds Ratio 95% Cl
Age, yr
<55 l.Ot l.Ot
55-64 0.69 0.51-0.94 1.10 0.65-1.72
65-74 0.67 0.50-0.91 0.90 0.57-1.42
75-84 0.47 0.35-0.65 0.64 0.40-1.02
85+ 0.19 0.13-0.28 0.23 0.14-0.38
Angina pectoris 1.29 1.07-1.56 1.29 1.04-1.59
Q-wave AMI 1.74 1.45-2.08 1.75 1.41-2.17
Died during the short-term hospitalization 3.04 2.46-3.77 3.97 3.20-4.93
Congestive heart failure 3.58 2.98-4.30
Cardiogenic shock 5.07 3.89-6.61
This entry was posted in Pulmonary function and tagged acute myocardial infarction, angina, catheterization, congestive heart failure, hospitalization.
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