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Outpatient cardiac catheterization: a report of 3,000 cases
1Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, Georgia.
Insights
Outpatient cardiac catheterization is safe and cost-effective for carefully selected patients, reducing hospital stays and saving time. Patient selection is crucial for minimizing complications and ensuring procedural safety.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Cardiac catheterization is a common diagnostic procedure.
- Outpatient cardiac catheterization offers potential cost and time savings.
- Safety concerns exist for performing invasive procedures in an outpatient setting.
Purpose of the Study:
- To describe the patient population undergoing cardiac catheterization as outpatients.
- To evaluate the safety and efficacy of outpatient cardiac catheterization.
- To assess the outcomes and complications in a large cohort of outpatients.
Main Methods:
- Retrospective analysis of 3000 cardiac catheterizations performed in an outpatient setting.
- Careful patient selection criteria were applied to exclude high-risk individuals.
- Use of small catheters to minimize bleeding complications.
Main Results:
- A significant percentage of patients had coronary artery disease (single, double, or triple-vessel disease).
- Low rates of major complications including ventricular fibrillation, cerebral emboli, pulmonary edema, and allergic reactions.
- Minimal groin bleeding requiring compression was observed.
Conclusions:
- Outpatient cardiac catheterization can be performed safely in carefully selected patients.
- The procedure offers significant time and cost savings.
- Meticulous patient selection and a well-prepared laboratory with hospital support are essential for minimizing emergencies and complications.
Abstract:
A total of 3000 patients have had cardiac catheterization in the Andreas Gruentzig Cardiovascular Laboratory of the Emory Clinic. The purpose of this presentation is to describe the patient population selected for this procedure and our experience with this group. The concept of catheterization as an outpatient is attractive from the standpoint of cost savings and time conservation. Safety has been questioned. We have found that this technique can be performed safely in carefully selected outpatients. Careful selection attempted to eliminate those with unstable symptoms, recent myocardial infarction, severe diabetes, and renal failure. Small catheters were used to minimize the potential for bleeding. Excellent opacification of vessels was obtained with these catheters. Despite careful screening we found 2.2% had significant left main obstruction, 10.8% had triple-vessel disease, 16.0% had double-vessel disease, and 23.5% had single-vessel disease, and a similar percentage had normal coronary arteriograms. Our patients experienced ventricular fibrillation on five occasions, there were two small cerebral emboli with reversible neurologic defects, two episodes of pulmonary edema, and two episodes of severe allergic reactions. Only three patients had significant groin bleeding at home that required compression of the site. We subsequently did angioplasty on 323 patients, performed cardiac surgery (mostly coronary bypass) on 187 patients, and admitted 18.2% of the entire group. We conclude that this procedure can be done safely in this carefully designed setting and it saves time and offers cost savings. Patient selection is very important to minimize potential emergency situations and complications. The laboratory must be carefully set up and provide a close relationship with a hospital capable of attending to any unexpected emergency.