Abstract
PurposePatients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV.MethodsThis was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models.ResultsMechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8–6.2), 13 (11.2–4.7), and 28 (18.0–37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40–1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79–5.26, P<0.001).ConclusionsIn AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients.
Highlights
17% of patients with acute myocardial infarction (AMI) typically experience respiratory impairment due to decompensated heart failure [1]
In AMI setting, 18% of the patients required mechanical ventilation (MV). Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death
Prior studies have shown that nearly 8% of patients with AMI are treated with invasive MV during their hospital stay [3], forming a very high-risk subgroup with almost 50% short-term mortality rates [4]
Summary
17% of patients with acute myocardial infarction (AMI) typically experience respiratory impairment due to decompensated heart failure [1]. Several trials and meta-analyses have demonstrated that non-invasive MV may be useful for the treatment of cardiogenic pulmonary edema [5,6] Both continuous positive airway pressure and bi-level positive airway pressure ventilation, by improving gas exchange and hemodynamics, have been proven effective and safe in reducing the need for endotracheal intubation [7]. Most of these studies were not performed in acutely ischemic patients, and only small trials have tested non-invasive MV in the setting of AMI [8,9]
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