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 and factors associated with pulmonary artery (PA) catheterization in patients hospitalized with acute myocardial infarction (AMI). DESIGN Nonconcurrent prospective study carried out in 16 teaching and community hospitals in Worcester, Mass, in seven time periods between 1975 and 1990. A total of 5,480 patients hospitalized with validated AMI comprised the study sample. RESULTS Use of PA catheterization increased from 1975 to 1984 with a consistent decline thereafter in all patients with AMI studied. Among the 2,441 patients with complicated AMI, use of PA catheterization increased from 1975 through 1988 with a decline in use in 1990. For the combined study periods, 14.7 percent of all patients with AMI studied and 25.4 percent of those with complicated AMI underwent PA catheterization. After adjusting for other potentially confounding 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 cardiogenic shock during the acute hospitalization were significantly more likely to undergo PA catheterization than respective comparison groups 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 complicated AMI. CONCLUSIONS The results of this multihospital, community-based study provide insight into changes over time in the use of PA catheterization and patient-related factors associated with receipt of PA catheterization in the setting of AMI.