0
Clinical Investigations: CARDIOLOGY |

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

Eftychios Siniorakis, MD; Spyridon Arvanitakis, MD; Giannis Voyatzopoulos, MD; Petros Hatziandreou, MD; Giannis Plataris, MD; Athanasios Alexandris, MD; Petros Bonoris, MD
Author and Funding Information

*From the Department of Cardiology, Coronary Care Unit, Elpis Municipal General Hospital, Athens, Greece.

Correspondence to: Eftychios Siniorakis, MD, Pallini Post Office, Box 67591, 15302 Athens, Greece



Chest. 2000;117(5):1286-1290. doi:10.1378/chest.117.5.1286
Text Size: A A A
Published online

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.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543