TEMPORAL TRENDS AND FACTORS ASSOCIATED WITH PULMONARY-ARTERY CATHETERIZATION IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Study objective: To examine changes over time in the utilization of an d factors associated with pulmonary artery (PA) catheterization in pat ients hospitalized with acute myocardial infarction (AMI). Design: Non concurrent prospective study carried out in 16 teaching and community hospitals in Worcester, Mass, in seven time periods between 1975 and 1 990. A total of 5,480 patients hospitalized with validated AMI compris ed the study sample. Results: Use of PA catheterization increased from 1975 to 1984 with a consistent decline thereafter in all patients wit h AMI studied. Among the 2,441 patients with complicated AMI, use of P A catheterization increased from 1975 through 1988 with a decline in u se in 1990. For the combined study periods, 14.7 percent of all patien ts with AMI studied and 25.4 percent of those with complicated AMI und erwent PA catheterization. After adjusting for other potentially confo unding factors through use of a logistic regression analysis, younger patients, those with a history of angina, those with Q-wave AMI, those who died, and those patients developing congestive heart failure or c ardiogenic shock during the acute hospitalization were significantly m ore likely to undergo PA catheterization than respective comparison gr oups among all patients with AMI studied. Younger age, occurrence of Q -wave AMI, and having died during the short-term hospitalization were associated with receipt of PA catheterization in patients with complic ated AMI. Conclusions: The results of this multihospital, community-ba sed study provide insight into changes over time in the use of PA cath eterization and patient-related factors associated with receipt of PA catheterization in the setting of AMI.