Early and long-term prognosis after vasodilator therapy in the acute phase of myocardial infarction.

Cautious administration of vasocilator agents with careful hemodynamic monitoring may improve cardiac function in many patients with severe pump failure and cardiogenic shock complicating myocardial infarction. However, the immediate prognosis tends to improve only in a specific subset of patients, that is, those with left ventricular stroke work index above 10 g.m/m2 and elevated left ventricular filling pressure. In the presence of very severe pump failure, cardiogenic shock, stroke work index of less than 10 g.m/m2 and grossly elevated left ventricular filling pressure, vasodilator therapy alone does not tend to improve in-hospital mortality. Furthermore, the long-term prognosis in the survivors with severe pump failure complicating myocardial infarction remains unfavorable. The poor prognosis of these patients is probably a result of the extensive myocardial necrosis sustained at the onset of infarction.