Relation between admission time, haemodynamic measurements, and prognosis in acute myocardial infarction.

dballoon catheter andmonitored for51±51hours in226patients admitted withanacute myocardial infarction (184 survivors and42non-survivors). Mortality was related totimeofadmission after onset ofsymptoms ofinfarction. Of69patients ingroup A 13died inhospital (188%)onetofour hours after onset; ingroupB(five toeight hours after onset) eight of 71patients (11%) died five toeight hours after onset; four of26patients ingroup C(15%) diednine to12hours after onset; 15of42patients (36%) ingroupDdied13to24hours after onset; andtwoof 18patients ingroupEdied(11%) morethan24hours after onset. Irrespective ofadmission time, haemodynamic findings insurvivors weresignificantly better thaninnon-survivors. During thefirst eight to12hours after onset ofinfarction cardiac index andstroke workindex werenormal orabove normal, withraised left ventricular filling pressures. Inpatients admitted later, this compensatory mechanism hadoften collapsed. Wherepumpfailure withsubnormal cardiac index andstroke work index werepresent mortality wasincreased. Allfour patients dying fromacute myocardial rupture hadsignificantly higher values ofcardiac indexandstroke workindexandlowervalues of pulmonary artery end-diastolic pressure compared withthose dying fromother causes. Although theinitial haemodynamic values givesomeprognostic information, longitudinal analysis provides insight into theevolving myocardial disturbance andcompensatory mechanisms. Iftheinitial values ofpulmonary artery end-diastolic pressure andcardiac andstroke workindices remain normal orbecome stable after atransient disturbance intheacute phase, prognosis isgood. If, however, these values deteriorate orremain abnormal, prognosis ispoor. Typically suchpatients havesuffered large infarctions withatendency toexpansion. Ifthehaemodynamic situation during thefirst 24hoursafter onset ofinfarction remains stable for12to15hours, haemodynamic monitoring maybestopped; thechance ofrelapse insuchpatients wasfound tobebelow 10%.Late deterioration, usually manifest byfurther painorbyelectrocardiographic orenzymechanges, should beanindication torestart haemodynamic monitoring sothat treatment canbechosen and adjusted optimally. Thesehaemodynamic measurements inpatients treated traditionally with vasodilators, positive inotropic agents, andfluid will formthebasis forcomparison ofmeasurements inpatients whoarenowtreated within thefirst eight hours with selective intracoronary thrombolysis and,ifpossible, withadjacent intracoronary balloon dilatation oftheunderlying coronary artery stenosis.

[1]  R. Erbel,et al.  [Early prognostic implications of haemodynamic findings in acute myocardial infarction (author's transl)]. , 2008, Deutsche medizinische Wochenschrift.

[2]  S. Matsui,et al.  Hemodynamic profile in acute myocardial infarction. , 1981, Japanese circulation journal.

[3]  Daniel S. Berman,et al.  Left ventricular ejection fraction determined by radionuclide ventriculography in early stages of first transmural myocardial infarction , 1980 .

[4]  U. Elkayam,et al.  Dynamic prognostic profile for acute myocardial infarction. , 1979, Chest.

[5]  B. Bulkley,et al.  Expansion of Transmural Myocardial Infarction A Pathophysiologic Factor in Cardiac Rupture , 1979, Circulation.

[6]  J. B. Garrison,et al.  Regional cardiac dilatation after acute myocardial infarction: recognition by two-dimensional echocardiography. , 1979, The New England journal of medicine.

[7]  J. Meyer.  Der frische Herzmuskelinfarkt — invasive Diagnostik , 1979 .

[8]  W. Merx.  Der frische Herzmuskelinfarkt — nicht invasive Diagnostik , 1979 .

[9]  J. Ross,et al.  Identification of high risk subsets of acute myocardial infarction , 1978 .

[10]  J. Meyer,et al.  Therapeutische Möglichkeiten in der Intensivstation , 1978 .

[11]  S. Effert,et al.  Left ventricular hemodynamics and function in acute myocardial infarction: studies during the acute phase, convalescence and late recovery. , 1977, The American journal of cardiology.

[12]  G. Diamond,et al.  Correlative classification of clinical and hemodynamic function after acute myocardial infarction. , 1977, The American journal of cardiology.

[13]  G. Diamond,et al.  Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts). , 1976, The New England journal of medicine.

[14]  S. Effert,et al.  [Significance of the size of an acute infarct for left ventricular haemodynamics (author's transl)]. , 1976, Deutsche medizinische Wochenschrift.

[15]  J. Forrester,et al.  Effects of Vasodilator Therapy for Severe Pump Failure in Acute Myocardial Infarction on Short‐term and Late Prognosis , 1976, Circulation.

[16]  P. Hanrath,et al.  Die Bedeutung der akuten Infarktgre fr die Hmodynamik des linken Ventrikels , 1976 .

[17]  P. Hanrath,et al.  [Hemodynamic basis of acute myocardial infarct therapy]. , 1975, Deutsche medizinische Wochenschrift.

[18]  A. D. Vorm.  Short-term Survival after Acute Myocardial Infarction Predicted by Hemodynamic Parameters , 1975 .

[19]  D. Mathey,et al.  Acute myocardial infarction. V: Left and right ventricular haemodynamics in cardiogenic shock. , 1974, British heart journal.

[20]  J. Forrester,et al.  Optimal level of filling pressure in the left side of the heart in acute myocardial infarction. , 1973, The New England journal of medicine.

[21]  B. Sobel,et al.  Estimation of Infarct Size in Man and its Relation to Prognosis , 1972, Circulation.

[22]  G. Diamond,et al.  Hemodynamic Spectrum of Myocardial Infarction and Cardiogenic Shock: A Conceptual Model , 1972, Circulation.

[23]  G. Diamond,et al.  Early increase in left ventricular compliance after myocardial infarction. , 1972, The Journal of clinical investigation.

[24]  J. Cohn,et al.  Improved left ventricular function during nitroprusside infusion in acute myocardial infarction. , 1972, Lancet.

[25]  R. Russell,et al.  Hemodynamic Evaluation of Left Ventricular Function in Shock Complicating Myocardial Infarction , 1972, Circulation.

[26]  G. Diamond,et al.  Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. , 1970, The New England journal of medicine.

[27]  T. Killip,et al.  Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. , 1967, The American journal of cardiology.