[Evaluation of the use of the pulmonary artery catheter in patients with acute myocardial infarct: The PAEEC study. Project of the Epidemiologic Analysis of Critical Illness]

Abstract

Background: The aim of the study was to evaluate the impact of the use of the pulmonary artery catheter on hospital mortality in patients admitted to hospital for acute myocardial infarction.

Patients and methods: This retrospective cohort study, included 1,721 patients whose main diagnosis was acute myocardial infarction and who were registered in the PAEEC study (a multicenter study including 86 intensive care units throughout Spain).

Results: A pulmonary artery catheter was implanted in 82 patients (4.8%). The mortality of the group with the catheter was 51.2%, being greater than that of the control group which did not receive the catheter (odds ratio [OR] = 8.56, 95% confidence interval [CI] range 5.25-13.93; p < 0.001). This excessive mortality persisted on adjusting for the APACHE-III, age, sex, diabetes, use of mechanical ventilation, vasoactive drugs and thrombolytic treatment (adjusted OR = 3.11; CI 1.59-5.57; p < 0.001). The TISS values of the patients in whom the catheter was implanted were greater than those expected for their age and APACHE-III level, being interpreted as an indicator of occult severity. On inclusion of the TISS values in the logistic regression model, the differences in mortality between the catheter and the control group decreased, but remained statistically significant (OR = 2.05; CI: 1.04-4.0; p = 0.039).

Conclusions: The use of the pulmonary artery catheter was not found to contribute to reducing the mortality of patients with acute myocardial infarction. In fact, these results questions its use, particularly in less severe patients.