Abstract
Routine right heart catheterization (RHC) provides limited prognostic information in medically treated patients with coronary artery disease. The use of this procedure in patients undergoing coronary artery bypass grafting has been more widely advocated. To determine the value of this practice, we investigated the added prognostic content of hemodynamic data obtained from 11 RHC variables in 1054 consecutive surgically treated patients (pts) with significant coronary artery disease ( ≥ 75% stenosis) between 8/6/69 and 1/1/80. During this period, RHC was performed routinely on all patients undergoing left heart catheterization (LHC). Follow up was 97% complete. Univariate RHC predictors of survival included pulmonary vascular resistance (PVR). right atrial mean (RAM). CO, CI, AVO 2 difference, RV systolic pressure, PA systolic, mean and diastolic pressures, and pulmonary capillary wedge pressure (p < 0.0001 for each). Age yrs (median) 52 (20-78) Male 83% EF (median) 53% (5-60) Hx of CHF 10.1% Prior MI 46.3% LVEDP (median) 11 mmHg Using a Cox model the independent predictive value of each RHC variable was analyzed when added to a prognostic model derived from clinical and LHC data. RAM (x 2 = 18.5, P < 0.001) and PVR (x 2 = 8.45, P < 0.001) added independent information to the standard clinical and invasive (left heart) prognostic factors. A significant interaction was found between PVR and EF (p = 0.0067) indicating that elevated PVR contained more prognostic information in patients with normal or elevated EF.
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