Complications from cardiac catheterization: Analysis of a military database

Background Cardiac catheterization is a common procedure in the United Stat es. Our purpose was to assess possible risk factors for complications from cardiac catheterization. Methods: The Civilian External Peer Review Program database, which contains data on 3,494 cardiac catheterizations performed at 28 military facilities from 1987 to 1989, provided the patient populatio n for this study, Of 360 abstracted clinical elements, 27 were selected by a panel of internists and cardiologists for evaluation as potential risk fa ctors and were analyzed using logistic regression. Complications were analy zed within three categories: major (myocardial infarction, cerebral vascula r accident, or death within 24 hours of catheterization); minor (hemorrhage requiring transfusion, pseudoaneurysm, fistula, or femoral thrombosis); an d any. Results: The mean age of the 3,494 patients was 56 years, and 75% of them were male; 85% were white, 10% were African-American, and 5% were oth er races. Complication rates were as follows: death (N = 13), 3.7/1,000; ce rebral vascular accident (N = 16), 4.1/1,000; myocardial infarction (N = 22 ), 5.6/1,000; hemorrhage (N = 20), 5.1/1,000 fistula (N = 7), 0.3/1,000: an d thrombosis (N = 15), 3.8/1,000. These were categorized as 59 major, 71 mi nor, or 122 any complications. Complications were more likely in patients w ith hypertension (odds ratio, 1.8; 95% confidence interval, 1.05-3.18), per ipheral vascular disease (odds ratio, 2.9; 95% confidence interval, 1.1-8.7 ), age greater than 60 years (odds ratio, 2.1; 95% confidence interval, 1.2 -3.8), and those undergoing angioplasty (odds ratio, 6.0; 95% confidence in terval, 2.9-12.2). Conclusions: Hypertension, age greater than 60 years, pe ripheral vascular disease, and procedures either nonelective or involving a ngioplasty all independently increased the risk of complications. There was a "dose-response" relationship between risk and number of risk factors. Th e risk of a complication may be greater than 10% in patients with more than three risk factors.