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• W1992436788 abstract "To the Editor: I read with interest in the December 1990 issue of Chest the article by Zion et al,1Zion MM Balkin J Rosenmann D Goldbourt U Reicher-Reiss H Kaplinsky E et al.Use of pulmonary artery catheters in patients with acute myocardial infarction: analysis of experience in 5,841 patients in the SPRINT Registry.Chest. 1990; 98: 1331-1335Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar regarding the use of pulmonary artery catheters in patients with acute myocardial infarction. In an accompanying editorial, Dalen2Dalen JE Does pulmonary artery catheterization benefit patients with acute myocardial infarction? [editorial].Chest. 1990; 98: 1313-1314Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar concluded that the pulmonary artery catheter has not been shown to be of benefit to the patient with acute myocardial infarction. This conclusion comes of asking a “wrong” question of a retrospective trial which lacks an appropriate basic design for accurately assessing the possible benefits that may accrue from the use of a pulmonary artery catheter. Dr Dalen would likely agree that the interpretation (or misinterpretation) of data derived from a pulmonary artery catheter will determine whether any further change of treatment ordered on the basis of these data is appropriate. Wrong decisions based on misinterpretation of data obviously cannot be expected to produce benefits. The recent report of variability in physicians' knowledge and interpretation of the data derived from a pulmonary artery catheter3Iberti TJ Fischer EP Leibowitz AB Panacek EA Silverstein JH Albertson TE et al.A multicenter study of physicians' knowledge of the pulmonary artery catheter.JAMA. 1990; 264: 2928-2932Crossref PubMed Scopus (391) Google Scholar (wherein roughly half the physicians in the study were unable to determine the wedge pressure from a clear tracing) necessitates that any study meant to assess the benefits of the pulmonary artery catheter must control for competence in the use and the interpretation of the derived data. Furthermore, patient benefit cannot be judged solely on the basis of hard end points, such as total mortality. The extent to which a patient is helped by the use of an investigation is dependent on the diagnostic, therapeutic, and prognostic utility of the investigation. Did the use of the pulmonary artery catheter help in the diagnosis of complications of acute myocardial infarction, such as septal rupture, mitral regurgitation, cardiac tamponade, and right ventricular infarction? Was it of incremental diagnostic benefit when compared with other noninvasive investigations, such as echocardiography, surface electrocardiography, and the cardiac nuclear scan? Were major therapeutic decisions made on the basis of the catheter-derived data? If so, what were these decisions and what were the treatment modalities used? Were the decisions made solely on the basis of clinical assessment sufficiently altered by the hemodynamic data derived from the pulmonary arterial catheter? This is important, since the clinical accuracy in the estimation of cardiac output and pulmonary wedge pressures is only about 50 percent.4Forrester JC Diamond G Swan HJ Correlative classification of clinical and hemodynamic function after acute myocardial infarction.Am J Cardiol. 1977; 39: 137-145Abstract Full Text PDF PubMed Scopus (297) Google Scholar Was the in-hospital morbidity in patients with a pulmonary artery catheter different from that in patients without one? Were the data derived from invasive monitoring of use to the physician in diagnosis, as shown in previous studies5Matthay MA Chatterjee K Bedside catheterization of the pulmonary arterv: risks compared with benefits.Ann Intern Med. 1988; 109: 826-834Crossref PubMed Scopus (107) Google Scholar? The study by Zion et al1Zion MM Balkin J Rosenmann D Goldbourt U Reicher-Reiss H Kaplinsky E et al.Use of pulmonary artery catheters in patients with acute myocardial infarction: analysis of experience in 5,841 patients in the SPRINT Registry.Chest. 1990; 98: 1331-1335Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar fails to answer these questions. However, it was not designed to answer them. The correct approach (which has been suggested by Dr Dalen) is a prospective randomized trial in which the incremental diagnostic utility (relative to other noninvasive investigations) and the therapeutic usefulness and prognostic utility of the pulmonary artery catheter are evaluated, including a cost-benefit analysis and controlling for physician competence in data interpretation as well! Until then, it would be wiser to reserve judgment on the usefulness of the pulmonary artery catheter in patients with acute myocardial infarction. On Being Fair to the Pulmonary Artery CatheterCHESTVol. 101Issue 2PreviewTo the Editor: Full-Text PDF" @default.
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• W1992436788 title "On Being Fair to the Pulmonary Artery Catheter" @default.
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