RISK OF MAJOR COMPLICATIONS FROM CORONARY ANGIOPLASTY PERFORMED IMMEDIATELY AFTER DIAGNOSTIC CORONARY ANGIOGRAPHY - RESULTS FROM THE REGISTRY OF THE SOCIETY FOR CARDIAC ANGIOGRAPHY AND INTERVENTIONS

Objectives. This study was designed to determine the risk of performin g percutaneous transluminal coronary angioplasty (PTCA) at the time of diagnostic catheterization (''combined procedures''). Background. Hea lth care providers are under increasing pressure to combine diagnostic and interventional coronary procedures to reduce costs. However, the risk associated with combined procedures has not been rigorously asses sed. Methods. A multicenter cohort study of 35,700 patients undergoing elective PTCA from 1992 through 1995 was performed to determine the r isk of major complications (myocardial infarction, emergency coronary artery bypass graft surgery or death) from combined relative to staged procedures (i.e., performing PTCA at a session subsequent to diagnost ic catheterization). Results. The risks of major complications from co mbined and staged procedures were 2.0% and 1.6%, respectively (unadjus ted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05 to 1.57). After adjusting for clinical and angiographic differences and clusteri ng by laboratory, the risk from combined procedures was not significan tly elevated (multivariable OR, 1.18, 95% CI 0.89 to 1.55). However, s everal subgroups of patients did have an increased risk from combined procedures: patients with multivessel disease (multivariable OR 1.64, 95% CI 1.13 to 2.39); women (multivariable OR 1.64, 95% CI 1.05 to 2.5 5); patients >65 years old (multivariable OR 1.40, 95% CI 1.02 to 1.93 ); and patients undergoing multilesion PTCA (multivariable OR 1.53, 95 % CI 1.06 to 2.21). The risk of combined relative to staged procedures decreased over the 4-year period (multivariable p = 0.029). Conclusio ns. Combining PTCA with diagnostic catheterization appears to be safe in many patients. However, several subgroups of patients may be at inc reased risk Careful patient selection will most likely remain critical to ensuring the safety of combined procedures. (C) 1997 by the Americ an College of Cardiology.