Safety of coronary arteriography in clinically stable patients following coronary bypass surgery

The frequent use of diagnostic coronary arteriography and its importance in evaluating results of intervention in clinical trials emphasize the necess ity of continued assessment of procedural risk. Several studies have descri bed such risks, but they have often included a diverse group of patients wi th varying levels of clinical stability. Furthermore, this risk has not bee n well established in a population of patients with saphenous vein bypass g rafts. There is need to define the risk of coronary arteriography in a grou p of patients who are both clinically similar and stable, and to evaluate t he influence of improved technology and increased operator experience on th e risk of the procedure. The National Heart, Lung, and Blood Institute-fund ed Post Coronary Artery Bypass Graft Trial offered the opportunity to evalu ate the risk of elective diagnostic coronary arteriography in clinically st able patients studied at two points in time: pre-enrollment and 4-5 years a fter study entry. In this group of 2,635 angiograms from clinically stable patients over 5 years there were no deaths and the risk of myocardial infar ction was 0.08%, while 0.7% had clinically important complications. Non-ele ctive, urgent studies (311 angiograms) on unstable patients were more likel y to include angioplasty and were associated with a risk of death of 0.6% a nd myocardial infarction of 1.3%. Complications did not vary with age or ge nder. Vascular trauma was more likely to occur using the brachial than the femoral artery entry sites, These results indicate that elective angiograph y on stable patients can be accomplished with a very low risk of mortality (0% in this study) or serious cardiovascular complication. This supports th e safety and usefulness of angiography for clinical intervention trials. Ca thet. Cardiovasc. Diagn. 45:376-381, 1998. (C) 1998 Wiley-Liss, Inc.