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Current complications of diagnostic and therapeutic cardiac catheterization
R M Wyman1, R D Safian, V Portway
1Charles A. Dana Research Institute, Boston, Massachusetts 02215.
Insights
This study analyzed 2,883 cardiac catheterizations, finding higher complication rates due to complex therapeutic procedures like percutaneous transluminal coronary angioplasty and balloon valvuloplasty in sicker patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Procedures
Background:
- Cardiac catheterization is a common diagnostic and therapeutic procedure.
- Assessing complication rates is crucial for patient safety and procedural improvement.
- Previous data may not reflect current trends in patient acuity and procedural complexity.
Purpose of the Study:
- To evaluate the complication profile of diagnostic and therapeutic cardiac catheterizations.
- To determine mortality and morbidity rates associated with specific interventional procedures.
- To compare current complication rates with historical data.
Main Methods:
- Retrospective analysis of 2,883 cardiac catheterizations performed between July 1986 and December 1987.
- Categorization of procedures into diagnostic catheterization, percutaneous transluminal coronary angioplasty (PTCA), and percutaneous balloon valvuloplasty.
- Collection and analysis of data on mortality, emergency surgery, cardiac perforation, and local vascular complications.
Main Results:
- Overall mortality rate was 0.28%, with variations by procedure: 0.12% for diagnostic, 0.3% for PTCA, and 1.5% for valvuloplasty.
- Local vascular complications occurred in 1.9% of patients, highest in valvuloplasty (7.5%).
- Cardiac perforation occurred in 0.2% of patients, predominantly during valvuloplasty, often requiring emergency surgery.
Conclusions:
- While diagnostic catheterization complication rates are favorable, overall rates are higher due to increased use of high-risk therapeutic procedures.
- Therapeutic procedures like PTCA and valvuloplasty carry higher intrinsic risks.
- Patient populations are increasingly complex, including older, sicker, and more unstable individuals, contributing to higher complication rates.
Abstract:
Data from 2,883 cardiac catheterizations performed during an 18 month period (from July 1986 through December 1987) were analyzed to assess the current complication profile of diagnostic and therapeutic procedures. Procedures performed during the study period included 1,609 diagnostic catheterizations, 933 percutaneous transluminal coronary angioplasties and 199 percutaneous balloon valvuloplasties. Overall, the mortality rate was 0.28% but ranged from 0.12% for diagnostic catheterizations to 0.3% for coronary angioplasty and 1.5% for balloon valvuloplasty. Emergency cardiac surgery was required in 12 angioplasty patients (1.2%). Cardiac perforation occurred in seven patients (0.2%), of whom six were undergoing valvuloplasty, and five (2.5% of valvuloplasty attempts) required emergency surgery for correction. Local vascular complications requiring operative repair occurred in 1.9% of patients overall, ranging from 1.6% for diagnostic catheterization to 1.5% for angioplasty and 7.5% for valvuloplasty. Although the complication rates for diagnostic catheterization compare favorably with those of previous multicenter registries, current overall complication rates are significantly higher because of the performance of therapeutic procedures with greater intrinsic risk and the inclusion of increasingly aged and acutely ill or unstable patients.