Early prognostic implications of haemodynamic findings in acute myocardial infarction (author's transl)

Abstract

Investigation of 226 patients with acute myocardial infarction showed that simultaneous assessment of end-diastolic pressure in the pulmonary artery as well as minute volume and arterial blood pressure enable a mostly reliable prognosis to be made. End-diastolic pulmonary artery pressure below 18 mm Hg, remaining so during the first two days of illness, is associated with mortality of around 7%. Initially increased values falling to below 18 mm Hg during the measurements are also linked with a good prognosis. An increase within the first 72 hours, as a consequence of progression of infarction or recurrence, increases mortality to around 23%. In cases where the initially increased end-diastolic pulmonary pressure cannot be lowered constantly, prognosis is also unfavourable due to chronic left heart failure in extensive cardiac infarction. The most certain prediction can be derived from the product of stroke volume and pressure, related to body surface. This stroke-work index does not only reflect pre- and after-loading of the left ventricle values mortality was 4%, rising to 88% with values below 25 g . m/m2. Haemodynamic monitoring is indicated for treatment surveillance particularly with vasodilators. Our results show that in addition a useful prognosis may be derived from the individual haemodynamic situation.