DEATH IN A CATHETERIZATION LABORATORY

Objective: To assess current rates of death from diagnostic and therap eutic 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. Pati ents: Consecutive patients undergoing diagnostic and therapeutic proce dures from 1977 to 1991. Those undergoing endomyocardial biopsy or ele ctrophysiologic study were excluded. Interventions: Cardiac catheteriz ation 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 proc edure. Results: There were 32 deaths attributed to 30 838 diagnostic c atheterization procedures, for a rate of 0.10%. The rate did not chang e significantly during the study period. Most (24 [75%]) of the 32 dea ths were related to coronary angiography; all but one of these patient s had left main-stem artery or triple-vessel disease. None of the case s of anaphylactoid reaction to the contrast medium resulted in death. Death from PTCA was largely confined to patients with unstable coronar y syndromes, including postinfarction shock. The rate of death from el ective 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 f rom angiography are those with unstable and global myocardial ischemia . The universal use of low-osmolar contrast medium is not justified gi ven the absence of fatal anaphylactoid reactions. The risk of death fr om elective PTCA is low, and patients at highest risk have unstable co ronary artery syndromes.