Usefulness of lung impedance-guided pre-emptive therapy to prevent pulmonary edema during ST-elevation myocardial infarction and to improve long-term outcomes
The American Journal of Cardiology, 07/06/2012
Shochat M et al. – LI–guided pre–emptive therapy in patients with ST–segment elevation myocardial infarction (STEMI) decreases the incidence of in–hospital pulmonary edema (PED) and results in better short– and long–term outcomes.Methods
- Five hundred sixty patients with STEMI and no signs of heart failure underwent LI monitoring for 84 ± 36 hours.
- Maximal LI decrease throughout monitoring did not exceed 12% in 347 patients who did not develop PED (group 1).
- In 213 patients LI reached the threshold level and, although still asymptomatic (Killip class I), these patients were then randomized to conventional (group 2, n = 142) or LI–guided (group 3, n = 71) pre–emptive therapy.
- In group 3, treatment was initiated at randomization (LI = –13.8 ± 0.6%).
- In contrast, conventionally treated patients (group 2) were treated only at onset of dyspnea occurring 4.1 ± 3.1 hours after randomization (LI = –25.8 ± 4.3%, p <0.001).
- All patients in group 2 but only 8 patients in group 3 (11%) developed Killip class II to IV PED (p <0.001).
- Unadjusted hospital mortality, length of stay, 1–year readmission rate, 6–year mortality, and new–onset heart failure occurred less in group 3 (p <0.001).
- Multivariate analysis adjusted for age, left ventricular ejection fraction, risk factors, peak creatine kinase, and admission creatinine and hemoglobin levels showed improved clinical outcome in group 3 (p <0.001).