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PubMed2005

[Spanish Cardiac Catheterization and Coronary Intervention Registry. 14th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2004)].

This article presents the findings of the Spanish Society of Cardiology registry of cardiac catheterization and interventional cardiology in the year 2004. Data were obtained from 121 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 110 performed catheterization mainly in adults, and 11 carried out procedures in only pediatric patients. In 2005, 111,451 diagnostic catheterization procedures were performed, including 97,785 coronary angiograms. This was 6.6% higher than in 2003. The population-adjusted rate was 2263 coronary angiograms per million inhabitants. A total of 45,469 coronary interventions were performed, 12% more than in 2003. The population-adjusted rate was 1052 per million inhabitants. Coronary stents were used in 91.4% of procedures; 68,892 stents were implanted, which was 12% more than in 2003. Of these, 25,148 (36.5%) were drug-eluting stents. Some 7326 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, 20.5% more than in 2003. These accounted for 16.1% of all percutaneous coronary interventions. Among non-coronary interventions, there was a decrease in the number of percutaneous mitral valvuloplasties (8%) and atrial septal defect closures (7%). In addition, there was a small increase in pediatric interventions (12%). Finally, it is important to note that the percentage of centers participating in the registry was high, what ensures that the data presented here are highly representative of the work carried out in cardiac catheterization laboratories in Spain.

Adult↗
PubMed2006

[Spanish Cardiac Catheterization and Coronary Intervention Registry. 15th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2005)].

This article summarizes the findings contained in the 2005 registry of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology. Data were obtained from 128 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 118 performed catheterizations mainly in adults, while 10 carried out procedures in only pediatric patients. In 2005, 117,245 diagnostic catheterization procedures were performed, including 103,646 coronary angiograms, which was 5.9% more than in 2004. The population-adjusted rate was 2326 coronary angiograms per million inhabitants. A total of 51,689 coronary interventions were performed, which is 13.6% more than in 2004 and which corresponds to a rate of 1161 per million inhabitants. Coronary stents were used in 96% of procedures. Of the 80,569 stents implanted, 41,352 (51.3%) were drugeluting stents. Some 8341 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, which is 13.8% more than in 2004. They accounted for 16.1% of all such interventions. Among the non-coronary interventions recorded, the number of percutaneous mitral valvuloplasties decreased by 7%. The number of procedures carried out to close atrial septal defects increased by 40% compared with 2004. The number of pediatric interventions increased by 1.7%. Finally, it is important to note that a large proportion of laboratories reported results, which helped to ensure that the data summarized here are highly representative of the work carried out at cardiac catheterization laboratories in Spain.

Angioplasty, Balloon, Coronary↗
PubMed1992

Pediatric interventional cardiac catheterization.

Interventional cardiac catheterization has become a standard part of the practice of pediatric cardiology. In this review, articles on pediatric interventional catheterization that have been published over the past 2 years are summarized. The interventional procedures have been divided into the following: lesions, pulmonary valve, aortic valve, mitral valve, coarctation of the aorta, branch pulmonary artery stenosis, device closure of septal defects, and miscellaneous lesions. In addition, within these lesions the articles have been further categorized in the following manner: 1) large collaborative studies defining the short-term efficacy and complications associated with many of the interventional procedures; 2) follow-up studies that now define the intermediate (1 to 8 years) hemodynamic results and complications associated with the various interventional procedures; 3) the reports of new cardiac lesions that can be treated within the catheterization laboratory; and 4) the description of new technologies that have improved the results or expanded the scope of interventional pediatric cardiology.

Aortic Coarctation↗
PubMed2003

Post-cardiac catheterization access site complications and low-molecular -weight heparin following cardiac catheterization.

The low molecular weight heparin enoxaparin is often administered to patients on long-term anticoagulation regimens who temporarily discontinue warfarin prior to undergoing invasive procedures. The clinical outcome of all enoxaparin-treated patients who underwent cardiac catheterization or coronary artery interventional procedures (n = 119) was evaluated. A total of 5 patients (4.2%) requiring anticoagulation (3 with chronic atrial fibrillation and 2 with ventricular thrombi) developed severe late enoxaparin-associated hemorrhagic or vascular complications at the femoral arterial puncture site between 3 and 11 days post-procedure. Complications included development of femoral arterial pseudoaneurysm (n = 3), hypotension (systolic blood pressure < 90 mmHg) (n = 2), acute decrease in hemoglobin levels to < 8.5 mg/dl (n = 4) and cardiac arrest (n = 1). In patients receiving standard dose enoxaparin after percutaneous invasive cardiac procedures, there is the potential for delayed and severe access site hemorrhagic and vascular complications.

Aged↗
PubMed1989

Wearing of caps and masks not necessary during cardiac catheterization.

Although cardiac catheterization-related infections are rare, caps and masks are often worn to minimize this complication. However, documentation of the value of caps and masks for this purpose is lacking. We, therefore, prospectively evaluated the experience of 504 patients undergoing percutaneous left heart catheterization, seeking evidence of a relationship between whether caps and/or masks were worn by the operators and the incidence of infection. No infections were found in any patient, regardless of whether a cap or mask was used. Thus, we found no evidence that caps or masks need to be worn during percutaneous cardiac catheterization.

Cardiac Catheterization↗
PubMed1998

Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization.

BACKGROUND: Most cardiac catheterizations are performed via femoral artery access. Reported rates of both peripheral vascular complications and success rates for the use of manual and mechanical compression techniques to achieve femoral artery hemostasis after cardiac catheterization vary. OBJECTIVE: To determine is use of a mechanical clamp is as effective as standard manual pressure for femoral artery hemostasis after cardiac catheterization. METHODS: Subjects consisted of 720 patients from 2 community hospitals who had elective diagnostic cardiac catheterization via the femoral artery. The control group (n=343) received manual compression for hemostasis; the study group (n=377) received mechanical compression. Standard protocols were used for the 2 compression techniques. Pressure was applied for a minimum of 10 minutes for 5F and 6F sheaths and catheters and for a minimum of 15 minutes for 7F and 8F sheaths and catheters. Prospective data were collected and analyzed for each patients, including sheath or catheter size, blood pressure, height, weight, age, time from administration of local anesthetic to successful cannulation of the femoral artery, anticoagulation status, total compression time, physician performing the catheterization procedure, nurse or technician who obtained hemostasis, and complications. In follow-up, patients were asked site-specific and functional status questions 1 to 2 days after the catheterization procedure and again 3 days after the catheterization procedure. RESULTS: Data were analyzed by using frequency distributions, measures of central tendency, and measures of variability. Only 1 difference between the 2 groups was significant: manual compression time was 14.93 +/- minutes, whereas mechanical compression time was 17.13 +/- minutes. CONCLUSION: Mechanical compression is as effective as manual compression for femoral artery hemostasis after cardiac catheterization.

Cardiac Catheterization↗
PubMed1999

Psychologic preparation to decrease anxiety associated with cardiac catheterization.

Undergoing a cardiac catheterization arouses anxiety of most patients. Coronary angiography plays an essential role in the diagnostic evaluation of the patient with suspected or known cardiac disease, and it is an important preoperative cardiac screening protocol for vascular surgery patients. Studies on psychologic preparation have concluded that preparatory techniques--specifically, sensory-perceptual informational and modeling--are beneficial in reducing patients' anxiety in various situations, including cardiac catheterization. The purpose of this study was to compare the preparatory informative (sensory and procedural data) and modeling strategies in reducing anxiety before cardiac catheterization. The research hypothesis that persons (n = 30) given a combination of sensory-perceptual informational preparation and modeling preparation would exhibit less anxiety than persons receiving one preparation alone was not supported. Although no significant difference existed between the postintervention anxiety scores for the 3 different treatment groups, a significant difference existed between the preintervention and postintervention anxiety scores overall. Therefore, this study validates the psychologic and nursing literature that states psychologic preparation is beneficial in reducing patients' anxiety before a stressful experience such as cardiac catheterization. The study findings also revealed an interesting trend for employing a modeling technique. This information contributes to nursing knowledge and may alter and make more effective the nature of standard psychologic preparation for patients undergoing any invasive procedure.

Adult↗
PubMed2006

Treating the right patient at the right time: Access to cardiac catheterization, percutaneous coronary intervention and cardiac surgery.

The Canadian Cardiovascular Society Access to Care Working Group was formed with a mandate to use the best science and information available to establish reasonable triage categories and safe wait times for common cardiovascular services and procedures through a series of commentaries. The present commentary discusses the rationale for access benchmarks for cardiac catheterization and revascularization procedures for patients with stable angina, and access benchmarks for cardiac catheterization and surgery for patients with valvular heart disease. Literature on standards of care, wait times and wait list management was reviewed. A survey of cardiac centres in Canada was performed to develop an inventory of current practices in identifying and triaging patients. The Working Group recommends the following medically acceptable wait times for access to cardiac catheterization: 14 days for symptomatic aortic stenosis and six weeks for patients with stable angina and other valvular disease. For percutaneous coronary intervention in stable patients with high-risk anatomy, immediate revascularization or a wait time of 14 days is recommended; six weeks is recommended for all other patients. The target for bypass surgery in those with high-risk anatomy or valve surgery in patients with symptomatic aortic stenosis is 14 days; for all others, the target is six weeks. All stakeholders must affirm the appropriateness of these standards and work continuously to achieve them. There is an ongoing need to continually reassess current risk stratification methods to limit adverse events in patients on waiting lists and assist clinicians in triaging patients for invasive therapies.

Angioplasty, Balloon, Coronary↗
PubMed1991

[An investigation of radiation exposure on pediatric patients and doctors during cardiac catheterization and cineangiography].

Cardiac catheterization and cineangiography are invasive diagnostic radiological examinations which exposure the patient to a relatively high radiation dose, the largest radiation dose of any diagnostic examination. Sixty-one infants and children, aged 28 days to 15 years, were randomly selected into this study to assess such questions regarding cardiac catheterization in children as; (1) How much the pediatric patient's and doctor's radiation exposure is during a routine cardiac catheterization and cineangiography? (2) What difference are there in exposure to various areas of the body? (3) How much radiation exposure is related to cineangiography compared with fluoroscopy? (4) How much radiation exposure may be reduced by lead apron worn by doctors? Thermoluminescent dosimeters containing 80 mg of CaSO4: Dy were applied to the body for the measurement of radiation exposure during cardiac catheterization. In hemodynamic assessment of catheterization (mean time 6 +/- 5 min), dosimeters were placed on various areas of the patient's skin and unexposed dosimeters were attached to mid sternum and right lateral chest during cineangiography (mean time 11 +/- 5 sec). Average skin doses over the patients' organs during catheterization and cineangiography were: eye 51 mu Gy, thyroid 746 mu Gy, sternum 5,102 mu Gy, right lateral chest 10,098 mu Gy, umbilicus 123 mu Gy and gonad 24 mu Gy. The radiation exposure during cineangiography at sternum and right lateral chest contributed to 61% and 70% of total exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology.

With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.

American Heart Association↗
PubMed1992

Mobile cardiac catheterization laboratories. Society for Cardiac Angiography and Interventions Laboratory Performance Standards Committee.

The Society of Cardiac Angiography and interventions proposed guidelines for the establishment of mobile cardiac catheterization laboratories. These laboratories should be established only in areas with genuine need, preferably as determined by an objective medical authority. Safety of the patient should be of paramount importance and specifications as to the selection of patients, transportation of patients with complications, the relationship to a tertiary care center, and quality assurance mechanisms are all addressed.

Cardiac Catheterization↗
PubMed2000

Evaluation of absorbed radiation dose to working staff during cardiac catheterization procedures.

BACKGROUND: Cardiac catheterization has been used frequently for the evaluation and treatment of patients with heart diseases. The working staff, particularly cardiologists who perform these procedures, have the highest potential risk of receiving high radiation doses due to close contact with patients. The purpose of this study was to measure and evaluate the accumulated radiation dosage of the cardiologists while they were performing clinical procedures in the cardiac catheterization laboratory. The working environment of the catheterization laboratory was also monitored for radiation. METHODS: Thermoluminescent dosimeters (TLDs) with very high sensitivity were employed for dose evaluations. They were taped to various parts of the body of the cardiologists during catheterization procedures. For environmental monitoring, TLDs were also distributed at several sites of the catheterization rooms for a period of 2 to 4 weeks. RESULTS: The study showed that the left wrist of the cardiologists received the highest radiation dose (338 microsieverts [microSv]/procedure) and the left lens received the second highest dose (149 microSv/procedure) during the procedures. The dose to the knees was unexpectedly high (92 microSv/procedure), partly due to radiation leakage from the lead curtain shielding under the patient couch. On average, the effective radiation dose per year was 37 mSv/y for a cardiologist who performs 10 catheterization procedures per week. Compare this to the occupational exposure limit of 50 mSv/y. The estimated accumulated equivalent dose to the lens was 152 mSv/y, which exceeded the regulatory limit for occupational exposure. CONCLUSIONS: Using proper lead shielding and increasing the distance from the radiation source are good strategies for reducing the radiation dose in medical staff. The work area outside the catheterization room was considered safe because the radiation level was essentially equivalent to the background radiation level.

Cardiac Catheterization↗