Hemodynamic Classification in Acute Myocardial Infarction : Has Anything Changed in the Last 3 Decades?

摘要

Objective: Current mortality (M1) in hemodynamic subgroups of patients with acute myocardialninfarction (AMI) was compared to that observed 30 years ago (M0), when hemodynamicnclassification was established. The prognostic value of oxyhemodynamic indexes in predicting M1nfor patients receiving right heart catheterization (RHC) was investigated.nPatients and methods:We assigned 393 patients with AMI (mean age, 72 6 10 years) to four Killipncategories. A fiberoptic reflectance catheter was inserted in the pulmonary artery (PA) in 136npatients. Cardiac index (CI), PA wedge pressure (PWP), PA mixed venous blood oxygen saturationn(SvO2), oxygen extraction ratio (O2ER), and normalized CI (NCI; CI/O2ER) were measured.nCatheterized patients were classified into four Forrester groups, and M1 and M0 were compared.nSurvivors (group S) were compared to nonsurvivors (group NS), and the prognostic value ofnoxyhemodynamic parameters in predicting M1 was estimated.nResults: A significant decline in total mortality was observed (M1 of 8% vs M0 of 34%; p < 0.0001).nIn catheterized patients, total M1 was also decreased (M1 of 15% vs M0 of 26%; p < 0.05).nCompared with group S, group NS had lower (mean 6 SD) CI (1.8 6 0.4 L/min/m2nvs 2.4 6 0.6nL/min/m2n;p < 0.01), SvO2 (46.1 6 10.6% vs 59.9 6 10.0%; p < 0.01), NCI (4.2 6 1.4 vs 7.4 6 4.1nL/min/m2n;p < 0.01), and higher PWP (22.7 6 6.8 mm Hg vs 14.4 6 4.7 mm Hg; p < 0.01). NCInpresented the best sensitivity (81%), specificity (78%), and predictive value (40%), in predictingnM1.nConclusions: The historical AMI hemodynamic classification has lost its semiquantitative value,nsince mortality has decreased. RHC does not compromise the outcome. NCI has a high prognosticnvalue in predicting early mortality. (CHEST 2000; 117:1286–1290)