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Death in a catheterization laboratory
B C Morton1, L A Higginson, D S Beanlands
1Division of Cardiology, University of Ottawa Heart Institute, Ont.
Insights
The death rate from cardiac catheterization has remained stable since 1977. Patients with unstable coronary syndromes face the highest risk during angiography and percutaneous transluminal coronary angioplasty (PTCA).
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Cardiac catheterization is a common diagnostic and therapeutic procedure.
- Assessing procedural mortality is crucial for patient safety and quality improvement.
- Understanding trends in cardiac catheterization outcomes is important for clinical practice.
Purpose of the Study:
- To evaluate the mortality rates associated with diagnostic and therapeutic cardiac catheterization.
- To determine if these mortality rates have changed between 1977 and 1991.
Main Methods:
- A prospective descriptive study was conducted at the University of Ottawa Heart Institute.
- Data were collected from consecutive patients undergoing cardiac catheterization (angiography, PTCA, valvuloplasty) between 1977 and 1991.
- Mortality was assessed within 24 hours post-procedure or later if causally related, excluding endomyocardial biopsy and electrophysiologic studies.
Main Results:
- The overall death rate for 30,838 diagnostic catheterizations was 0.10% and remained consistent throughout the study period.
- Most deaths (75%) were linked to coronary angiography in patients with left main-stem or triple-vessel disease.
- Deaths from PTCA were primarily observed in patients with unstable coronary syndromes; the rate for elective PTCA was approximately 0.1%.
Conclusions:
- Mortality rates for cardiac catheterization at this institution have remained stable from 1977 to 1991.
- Patients with unstable and global myocardial ischemia are at the highest risk during angiography.
- Elective PTCA carries a low risk of death, particularly for patients with unstable coronary artery syndromes.
Objective:
To assess current rates of death from diagnostic and therapeutic cardiac catheterization as well as changes in the rates, if any, from 1977 to 1991.
Design:
A prospective descriptive study.
Setting:
Catheterization laboratory, University of Ottawa Heart Institute.
Patients:
Consecutive patients undergoing diagnostic and therapeutic procedures from 1977 to 1991. Those undergoing endomyocardial biopsy or electrophysiologic study were excluded.
Interventions:
Cardiac catheterization with angiography, percutaneous transluminal coronary angioplasty (PTCA) or valvuloplasty.
Main Outcome Measures:
Rates of death within 24 hours after the procedure or later if causally related to the procedure.
Results:
There were 32 deaths attributed to 30,838 diagnostic catheterization procedures, for a rate of 0.10%. The rate did not change significantly during the study period. Most (24 [75%]) of the 32 deaths were related to coronary angiography; all but one of these patients had left main-stem artery or triple-vessel disease. None of the cases of anaphylactoid reaction to the contrast medium resulted in death. Death from PTCA was largely confined to patients with unstable coronary syndromes, including postinfarction shock. The rate of death from elective PTCA was approximately 0.1%.
Conclusions:
The death rate in our catheterization laboratory has remained the same since 1977, despite changes in the patient population. Patients at highest risk of death from angiography are those with unstable and global myocardial ischemia. The universal use of low-osmolar contrast medium is not justified given the absence of fatal anaphylactoid reactions. The risk of death from elective PTCA is low, and patients at highest risk have unstable coronary artery syndromes.