FREQUENCY, RISK-FACTORS, AND OUTCOME FOR BACTEREMIA AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

The objectives of this study were to examine bacteremias after percuta neous transluminal coronary angioplasty (PTCA) with respect to inciden ce, outcome, and risk factors. Patients undergoing PTCA from January 1 990 through April 1994 were studied; during this period a total of 4,2 17 PTCAs were performed in 3,473 patients. With use of predefined clin ical and microbiologic criteria, bacteremias were divided into 3 categ ories according to the relation to the PTCA procedure: PTCA-related, u nrelated, and indeterminate. Ninety-one patients with at least 1 posit ive blood culture during a 7-week period after PTCA were identified. T he bacteremia was classified as unrelated to the PTCA procedure in 32 patients, PTCA-related in 27, and indeterminant in the remaining 32 pa tients. The attack rate of PTCA-related bacteremia during the 52-month period was 0.64%. The most common organisms causing PTCA-related bact eremia were Staphylococcus aureus (14 patients), coagulase-negative st aphylococci (9 patients) and group B streptococci (6 patients). Septic complications, which included femoral artery mycotic aneurysm, septic arthritis, and septic thrombosis, occurred in 10 patients (0.24%). In dependent risk factors for PTCA-related bacteremia included duration o f procedure (odds ratio [OR] 2.9; p = 0.04), number of catheterization s at the same site (OR 4.0; p = 0.015), difficult vascular access (OR 14.9; p = 0.007), arterial sheath in place >1 day (OR 6.8; p = 0.025), congestive heart failure (OR 43.3; p = 0.002). Thus, PTCA-related bac teremia is an infrequent complication of PTCA but can be associated wi th significant morbidity, particularly when the infecting organism is S. aureus. Four of the 5 risk factors for PTCA-related bacteremia appe ar to correlate directly with increased vascular injury or maintenance of the arterial entry for the procedure. (C) 1997 by Excerpta Medica, Inc.