Death in a catheterization laboratory

Abstract

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.