MOBILE CARDIAC-CATHETERIZATION REGISTRY - REPORT OF THE FIRST 1,001 PATIENTS

The purpose of this study was to evaluate prospectively the efficacy a nd safety of mobile cardiac catheterization. Mobile cardiac catheteriz ation was introduced into clinical practice in 1989, but there has bee n no systematic study of its performance and safety. A registry was es tablished in 1989 to monitor outcomes with mobile cardiac catheterizat ion and is reported here. Patients were screened for eligibility for m obile cardiac catheterization using the joint AHA/ACC criteria for out patient angiography. Eligible patients underwent mobile catheterizatio n at eight hospitals within 120 miles of the base tertiary center. Hel icopter evacuation services were available at each mobile site. The in dications, findings, dispositions, and complications of mobile cardiac catheterization were recorded by means of a checklist, telephone foll ow-up and chart review. A total of 1,001 consecutive patients were ent ered into the registry in the first 20 months of operation, including 436 females and 565 males aged 22 to 84 years. Angina (Canadian Classe s II-IV) was the most frequent primary indication for catheterization (46.4%), followed by atypical chest pain (36.9%), or a positive exerci se stress test (25.6%). Infrequent indications for catheterization inc luded a history of myocardial infarction (5.6%), congestive heart fail ure (7.1%), arrhythmias (4.1%), and valvular heart disease (0.7%). Cat heterization was accomplished in 99.9% of patients. Angiographically n ormal studies were observed in 22.8%, and mild (less than or equal to 50%) coronary artery disease in 13.6% of patients. Significant one, tw o, and three vessel coronary artery disease was observed in 19.7, 16.0 , and 18.0% respectively, and left mainstem disease was seen in 4.7% o f patients. Only 27% required further referral to a tertiary site for additional diagnostic procedures, interventions, or surgery. Urgent re ferral for clinical instability was necessary in 0.9%, and major compl ications occurred in only 0.6% of patients. There were no deaths. When the joint AHA/ACC screening criteria for outpatient catheterization a re used, a low risk population of patients can be appropriately identi fied for mobile cardiac catheterization. Mobile catheterization can be accomplished with a high procedural success rate and few complication s. Most patients do not need further referral to a tertiary site for a dditional procedures. Mobile cardiac catheterization thus appears to b e a safe and effective means of diagnostic angiography. (C) 1994 Wiley -Liss, Inc.