Objective: Current mortality (M1) in
hemodynamic subgroups of patients with acute myocardial infarction
(AMI) was compared to that observed 30 years ago (M0), when
hemodynamic classification was established. The prognostic value of
oxyhemodynamic indexes in predicting M1 for patients
receiving right heart catheterization (RHC) was investigated.
Patients and methods: We assigned 393 patients with AMI
(mean age, 72 ± 10 years) to four Killip categories. A fiberoptic
reflectance catheter was inserted in the pulmonary artery (PA) in 136
patients. Cardiac index (CI), PA wedge pressure (PWP), PA mixed venous
blood oxygen saturation (Svo2), oxygen
extraction ratio (O2ER), and normalized CI (NCI;
CI/O2ER) were measured. Catheterized patients were
classified into four Forrester groups, and M1 and
M0 were compared. Survivors (group S) were compared to
nonsurvivors (group NS), and the prognostic value of oxyhemodynamic
parameters in predicting M1 was estimated.
Results: A significant decline in total mortality was
observed (M1 of 8% vs M0 of 34%;
p < 0.0001). In catheterized patients, total M1 was also
decreased (M1 of 15% vs M0 of 26%;
p < 0.05). Compared with group S, group NS had lower (mean ± SD) CI
(1.8 ± 0.4 L/min/m2 vs 2.4 ± 0.6
L/min/m2; p < 0.01), Svo2
(46.1 ± 10.6% vs 59.9 ± 10.0%; p < 0.01), NCI (4.2 ± 1.4
vs 7.4 ± 4.1 L/min/m2; p < 0.01), and higher PWP
(22.7 ± 6.8 mm Hg vs 14.4 ± 4.7 mm Hg; p < 0.01). NCI
presented the best sensitivity (81%), specificity (78%), and
predictive value (40%), in predicting M1.
Conclusions: The historical AMI hemodynamic classification
has lost its semiquantitative value, since mortality has decreased. RHC
does not compromise the outcome. NCI has a high prognostic value in
predicting early mortality.