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PubMed2004

Revascularization use and survival outcomes after cardiac catheterization in British Columbia and Alberta.

BACKGROUND: Alberta and British Columbia have comprehensive cardiac databases that provide detailed demographic, clinical and procedural data, including coronary anatomy, on all patients undergoing cardiac catheterization. OBJECTIVES: To examine the baseline clinical characteristics of patients undergoing cardiac catheterization, describe the use of revascularization treatments (percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]) following catheterization, and describe survival after cardiac catheterization, stratified by treatment strategy received and proposed, using cardiac databases from Alberta and British Columbia. PATIENTS AND METHODS: All patients between 20 and 105 years of age, admitted to hospital for their first coronary angiography between April 1, 1995, and March 31, 2001, with angiographic evidence of coronary disease were included in the study. Procedure volumes, baseline characteristics and therapy received within one year of cardiac catheterization are described by province. Stepwise, multivariate logistic regression analysis was used to model determinants of the revascularization modality. Kaplan-Meier curves of one-year survival after index cardiac catheterization were estimated for the therapy received (Alberta and British Columbia) and the therapy proposed (British Columbia only). RESULTS: Patients were predominantly men (70%), commonly presented with two- or three-vessel disease, and frequently had hypertension, a history of myocardial infarction and dyslipidemia. Within one year of catheterization, 21% to 26% underwent CABG and 32% to 42% underwent PCI. Emergency or urgent status at the time of catheterization was associated with receiving PCI, while three-vessel and left main disease were associated with receiving CABG. Patients who did not undergo revascularization within one year (presumed medical therapy) had the lowest one-year survival rate (93.4%; 95% CI 92.1% to 94.7%); this group comprised patients receiving medical therapy as proposed (one-year survival rate of 95.7%, 95% CI 94.6% to 96.8%), as well as patients receiving medical therapy at variance with the proposal for revascularization (84.6%; 95% CI 80.5% to 88.9%). CONCLUSIONS: Between 53.1% and 67.5% of patients presenting for cardiac catheterization undergo revascularization within one year. Urgent status increased the probability of PCI, and anatomy (ie, three-vessel and left main) increased the probability of CABG. Patients not undergoing proposed revascularization by one year had poorer outcomes, in contrast with those proposed for medical therapy, who had excellent outcomes.

Adult↗
PubMed1994

Vascular complications of cardiac catheterization.

Peripheral vascular complications after cardiac catheterization constitute an increasing portion of traumatic vascular injuries. To determine the incidence of these complications and the sequelae of their treatment, we reviewed 7,690 catheterizations performed over a 40-month period. One hundred eleven vascular complications were detected (1%), 41 of which required surgical repair (0.5%). Pseudoaneurysm (10), arteriovenous fistula (4), thromboembolism (9), infection (5), and other bleeding complications (83) were all found. Significantly more complications occurred in patients who were older than 60 years of age or female (P < 0.0009). In addition, the likelihood of a vascular injury after coronary angioplasty was significantly higher than after angiography alone (3% versus 1%, P < 0.00001). Secondary local and systemic complications after surgical repair were more frequent compared with those injuries that were managed nonoperatively (32% versus 11%; P = 0.015). Vascular complications continue to be a significant problem after cardiac catheterization, especially when coronary angioplasty is performed. The sequelae of surgical repair are significant, adding to their morbidity. Periodic review of these complications may identify factors that might be modified to reduce complications.

Aneurysm, False↗
PubMedDate not supplied

The effects of back massage before diagnostic cardiac catheterization.

CONTEXT: Admission to the hospital for a diagnostic cardiac catheterization can be perceived as a threat to one's health status. Autonomic nervous system arousal, particularly the sympathetic division, can elicit negative physiological and psychological human responses as a reaction to this threat. OBJECTIVE: The purpose of this study was to measure the effects of a 20-minute back massage on the physiological and psychological human responses of patients admitted for a diagnostic cardiac catheterization. DESIGN: A randomized clinical trial design was used. Data were compared in a repeated measures design before massage (T1), immediately following the back massage or standard care (T2), and 10 minutes later (T3). SETTING: A large urban academic medical center. PARTICIPANTS: Forty-six subjects admitted from home for a diagnostic cardiac catheterization. MAIN OUTCOME MEASURES: Heart rate, heart rate variability, blood pressure, respiration, peripheral skin temperature, pain perception, and psychological state. INTERVENTION: A 20-minute back massage. RESULTS: There was a significant difference between subject effect for group, with a reduction in systolic blood pressure in the treatment group (F = 8.6, P < .05). In addition, main effects were noted for time for diastolic blood pressure (F = 5.44; P < .006), respiration (F = 10.6; P < .005), total Profile of Mood States score (F = 5.9; P < .001) and pain perception (F = 4.09; P < .04) in both groups. CONCLUSIONS: A 20-minute back massage appeared to reduce systolic blood pressure in patients awaiting a diagnostic cardiac catheterization, while preparatory time in the cardiac catheterization laboratory appeared to reduce diastolic blood pressure, respiration, perceived psychological distress, and pain.

Adaptation, Psychological↗
PubMed2006

Predictors for the development of elevated anti-heparin/platelet factor 4 antibody titers in patients undergoing cardiac catheterization.

A substantial proportion of patients who undergo cardiac catheterization develop antibodies directed against the heparin/platelet factor 4 (PF4) complex after the procedure, which have been implicated in the pathogenesis of heparin-induced thrombocytopenia. This study attempted to identify factors that predicted the development of these antibodies in a prospective cohort study. Antiheparin/PF4 antibody titers were measured at baseline and again 5 +/- 2 days after cardiac catheterization by enzyme-linked immunosorbent assay. A total of 311 patients who underwent cardiac catheterization were included in the analysis. Of these, 25 (8.0%) developed positive antibody levels after catheterization. Patients who had positive antibody test results after catheterization had significantly greater baseline antiheparin/PF4 antibody titers compared with those whose titers remained low (optical density 0.227 vs 0.158, p < 0.001). In a logistic regression model, greater baseline antibody titers, a history of heparin exposure, and a lower platelet count at enrollment were the strongest predictors of conversion to positive antiheparin/PF4 antibody titers after cardiac catheterization. It is possible to identify patients at high risk for developing elevated titers of antiheparin/PF4 antibodies on the basis of their baseline clinical characteristics.

Antibodies↗
PubMed2000

Complications from cardiac catheterization: analysis of a military database.

BACKGROUND: Cardiac catheterization is a common procedure in the United States. 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 population for this study. Of 360 abstracted clinical elements, 27 were selected by a panel of internists and cardiologists for evaluation as potential risk factors and were analyzed using logistic regression. Complications were analyzed within three categories: major (myocardial infarction, cerebral vascular accident, or death within 24 hours of catheterization); minor (hemorrhage requiring transfusion, pseudoaneurysm, fistula, or femoral thrombosis); and 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 other races. Complication rates were as follows: death (N = 13), 3.7/1,000; cerebral 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; and thrombosis (N = 15), 3.8/1,000. These were categorized as 59 major, 71 minor, or 122 any complications. Complications were more likely in patients with hypertension (odds ratio, 1.8; 95% confidence interval, 1.05-3.18), peripheral 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 interval, 2.9-12.2). CONCLUSIONS: Hypertension, age greater than 60 years, peripheral vascular disease, and procedures either nonelective or involving angioplasty all independently increased the risk of complications. There was a "dose-response" relationship between risk and number of risk factors. The risk of a complication may be greater than 10% in patients with more than three risk factors.

Cardiac Catheterization↗
PubMed1975

Cardiac catheterization in small infants: the percutaneous approach.

Cardiac catheterization of small infants can be performed by the percutaneous technique using materials readily available from commercial sources. Twenty infants averaging 3.0 kg (range 1.3 to 4.1 kg) underwent percutaneous sheath cardiac catheterization in a 12 month period. After refinement of the technique, cardiac catheterization in all small infants was attempted percutaneously with a 90 percent rate of success. This percutaneous approach has distinct advantages for the small infant because it is performed rapidly, preserves venous integrity and has a low rate of morbidity.

Cardiac Catheterization↗
PubMed1986

Coronary angioplasty at the time of initial cardiac catheterization.

Following initial diagnostic cardiac catheterization in 20 patients with unstable angina, percutaneous transluminal angioplasty (PTCA) was successfully performed either immediately (15 patients) or later in the day (five patients). This approach offers certain clinical and financial advantages. PTCA immediately following diagnostic catheterization should probably only be performed by experienced operators and only when excellent cooperation with cardiovascular surgeons is possible.

Adult↗
PubMed1989

Streptokinase use in children undergoing cardiac catheterization.

The development of cardiac catheterization procedures in the pediatric population has evolved from diagnostic in nature to present day advanced technology and interventions. A complication of vessel occlusion secondary to large catheters, length of procedures, and patient size requires immediate intervention. The advent of thrombolytic agents has provided a highly effective mode of treatment in restoring circulation. The use of streptokinase, its efficacy, side effects, and nursing management are discussed.

Cardiac Catheterization↗
PubMed1980

Detection of endotoxin on sterile catheters used for cardiac catheterization.

Pyrogen reactions during cardiac catheterization are an alarming complication that frightens patients and baffles many physicans. This report describes a simple, reproducible, precise technique for the measurement of endotoxin-like activity on the inner and outer surfaces of catheters intended for intravascular insertion. This technique is useful in documenting the cause of patient reactions. Quality control procedures should be instituted following the manufacture of angiographic catheters so that pyrogen-free products are availabe for patient use. Catheters processed in a hospital are easily contaminated with fever-producing lipopolysaccharides from tap water or from bacterial growth in residual moisture. Sterilization by steam or ethylene oxide does not destroy these lipopolysaccharides. Consequently, reprocessing reusable catheters must include concern for removing lipopolysaccharides as well as sterilization.

Cardiac Catheterization↗
PubMed1996

Reducing time in bed after cardiac catheterization (TIBS II)

BACKGROUND: More than 500,000 cardiac catheterizations are done annually in the United States for both the diagnosis and treatment of patients with coronary artery disease. A femoral artery catheter insertion site is usually used for these procedures, and postprocedure protocols call for prolonged bed rest with restricted patient movement. Time-in-bed standards vary widely, from 3 to 12 hours after cardiac catheterization to more than 24 hours of bed rest after angioplasty. Bed rest with restricted movement causes patient discomfort, increases nursing workload, and prolongs length of hospital stay. OBJECTIVE: To determine if there would be a significant difference in the incidence of bleeding from femoral artery insertion sites between cardiac catheterization patients who remained in bed for 4 hours and those who remained in bed for 6 hours after sheath removal. METHODS: An experimental-control group design was used with a convenience sample (N = 86) of adult patients undergoing diagnostic coronary angiography. Patients were randomly assigned to remain in bed for 4 hours (experimental) or 6 hours (control) after arterial sheath removal. Both groups had pressure dressings and sandbags in place over the insertion site during time in bed. RESULTS: There was no significant difference in the incidence of bleeding related to out-of-bed activity between the groups (chi-square = .31, df = 1). CONCLUSIONS: Requisite time in bed after cardiac catheterization can be safely decreased from 6 to 4 hours. This change has implications for enhancing patient comfort and decreasing both length of hospital stay and healthcare costs.

Aged↗
PubMedDate not supplied

1992 hospital charges for two major surgical procedures for cardiovascular diseases. Part II: Cardiac catheterization.

In-hospital cardiac catheterization (CC) charges among MetLife group health insureds and their dependents averaged $10,880 during 1992. Among the 24 states in which 50 or more CCs were performed, the average total charges ranged from a low of $6,400 in Maryland to a high of $17,600 in California. Not only were these California charges 2.75 times higher than the lowest ones, they were also 62 percent higher than the U.S. average. Illinois registered the second highest average total charges ($14,340) and Wisconsin reported the second lowest ($7,320). On average, the hospital portion of the CC charges accounted for 82 percent of the total, ranging from 86 percent of the total charges in California, Colorado and Alabama to 70 percent in New York and 71 percent in New Jersey. Ancillary fees accounted for 62 percent of the total hospital charges and averaged $5,530 across the country. Physician fees averaged $2,000 for a CC in 1992, with these charges being the highest in California ($2,550--28 percent above the U.S. average) and the lowest in South Carolina ($1,300--32 percent below the norm for the country). Length of stay averaged four days with very little variation evident between regions or states.

Adult↗
PubMed2002

Race and sex differences in the refusal of cardiac catheterization among elderly patients hospitalized with acute myocardial infarction.

BACKGROUND: Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by patient race or sex. METHODS: We evaluated medical records of 74,745 Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 to ascertain refusal of cardiac catheterization during hospitalization. Patient race and sex were evaluated for their association with cardiac catheterization refusal adjusting for patient, physician, and hospital characteristics. RESULTS: The cardiac catheterization refusal rate in the overall cohort was 2.92% (95% CI 2.80%-3.04%). Race and sex differences in cardiac catheterization were observed after multivariate adjustment, with white women (odds ratio [OR] 1.28), black men (OR 1.34), and black women (OR 1.37) more likely to refuse cardiac catheterization than white men (OR 1.00). Relative differences in refusal were associated with only modest absolute differences in risk-standardized rates of cardiac catheterization refusal; rates were lowest for white men (2.55%), and higher for white women (3.21%), black men (3.36%), and black women (3.38%, P <.001 for global comparison). CONCLUSIONS: Patient race and sex were associated with cardiac catheterization refusal among elderly patients hospitalized with AMI. However, absolute race and sex differences in rates of procedure refusal were small, suggesting that race and sex differences in cardiac catheterization refusal provide only a partial explanation of observed differences in cardiac procedure use.

Black or African American↗
PubMedDate not supplied

The safety of performing diagnostic cardiac catheterizations in a mobile catheterization laboratory at primary care hospitals.

The benefits of mobile cardiac catheterization laboratories include keeping patients closer to their families, communities, local hospitals, and primary care physicians while receiving services comparable to those available at tertiary centers. However, there are very few studies regarding the safety of performing cardiac catheterization in mobile laboratories at remote locations. Thus, the authors performed an observational study of 1,775 consecutive patients undergoing a diagnostic cardiac catheterization in a mobile catheterization laboratory at primary care hospitals served by the Appleton Heart Institute (AHI) from August 1, 1991, to December 31, 1998. Twenty-three percent (1,775/7,637) of all AHI diagnostic cases in this time period were performed in the mobile catheterization laboratory. Urgent transfer to the tertiary care facility via ambulance or helicopter was used for 2.3% of patients (n = 41). The overall complication rate was 1.2% (n = 21). Of the patients who underwent cardiac catheterization in the mobile laboratory, 32.6% (n = 579) were subsequently referred for interventional or surgical revascularization. There were no deaths. Cardiac catheterizations can be performed safely in a mobile laboratory at primary care hospitals, provided that immediate transfer is available for those in need of urgent intervention or revascularization and that unstable patients are not studied in the mobile laboratory.

Adult↗
PubMed2005

Recent advances in non-interventional pediatric cardiac catheterization.

PURPOSE OF REVIEW: The role of cardiac catheterization in pediatric cardiology has changed significantly in the past 10-15 years. As interventional procedures dominate the field, it is important to examine the recent advances in non-interventional pediatric cardiac catheterization. RECENT FINDINGS: Meaningful and accurate data must be acquired for the presurgical evaluation of patients with congenital heart disease to better guide clinical decisions. In particular, all patients with single- ventricle physiology currently undergo diagnostic catheterization before bidirectional Glenn and Fontan surgeries. Recent studies are beginning to identify a subset of these patients who may not need to undergo presurgical catheterization. As surgical techniques evolve, diagnostic catheterization has a role in the analysis of hemodynamic variables and clinical outcomes. This can be seen in recent papers that examine the Sano modification to the Norwood procedure.Recent papers demonstrate the continued development of new techniques, new technology, and a progression towards smaller equipment. The use of conductance catheters, Doppler flow wires, and smaller traditional catheters will allow the pediatric cardiologist to more accurately and safely evaluate hemodynamic parameters. SUMMARY: Non-interventional pediatric cardiac catheterization continues to have an important role in the assessment and treatment of patients with congenital heart disease.

Cardiac Catheterization↗
PubMed1988

A prospective randomized trial of outpatient versus inpatient cardiac catheterization.

To evaluate the safety and cost of outpatient cardiac catheterization, we conducted a randomized trial at three hospitals of outpatient (n = 192) as compared with inpatient (n = 189) cardiac catheterization in low-risk patients. Outpatients had the following complication rates as compared with inpatients: hematoma, 12 versus 8.5 percent; numbness or weakness of extremity, 0.5 versus 1.6 percent; cold or blue extremity, 1.6 versus 1.1 percent; and acute myocardial infarction, 1.6 versus 0.5 percent. None of these differences were statistically significant. No deaths or strokes occurred in either group. Twenty-three patients (12 percent) assigned to the outpatient group required hospitalization because of complications of catheterization. In the outpatient group, the relative risk for hematoma was 1.42 (95 percent confidence interval, 0.77 to 2.29), and the relative risk for myocardial infarction within one week was 2.95 (95 percent confidence interval, 0.3 to 28.1). There were no significant differences between the two groups in whether they resumed normal activities or in the rates of rehospitalization within one week of the procedure. Total catheterization-related charges per patient were $679 lower for outpatients, with a savings in total hospital charges (including charges for subsequent therapeutic procedures) of $885 per patient. We conclude that elective cardiac catheterization as an outpatient procedure for selected patients is feasible and safe. Given the small size of our sample, however, we urge caution in interpreting these findings, since they do not exclude a small increase in complication rates with outpatient cardiac catheterization.

Ambulatory Care↗
PubMed1997

Predictors of same-admission cardiac catheterization in patients with acute ischemic syndromes.

BACKGROUND: Various strategies exist for the use of cardiac catheterization in unstable angina or non-Q wave myocardial infarction. At the authors' institution, the overall volume of cardiac catheterization has increased in recent years. OBJECTIVE: To investigate whether this increased volume of cardiac catheterization was due to adoption of a more invasive approach to the management of patients with acute ischemic syndromes. DESIGN: A retrospective cohort study was conducted using detailed chart review of coronary care unit admissions during 1990/91 and 1993/94. SETTING: A university-affiliated tertiary care referral centre with facilities for cardiac catheterization. PATIENTS: One hundred patients randomly selected from among those with unstable angina, non-Q wave myocardial infarction or chest pain not yet diagnosed in each of the study years. Detailed follow-up was complete for all patients. OUTCOME MEASURE: The use of cardiac catheterization during the index admission was documented. MAIN RESULTS: There was a trend towards more frequent use of same admission cardiac catheterization in the later period (21% [CI 14% to 31%] versus 12% [CI 7% to 20%], P = 0.09). However, after controlling for baseline characteristics and in-hospital events, the year of admission did not independently predict the use of catheterization (P = 0.60). By multivariate logistic regression, recurrence of chest pain and evidence of myocardial necrosis were most closely associated with same-admission cardiac catheterization. CONCLUSIONS: Although clinical factors partially explain the increased use of catheterization over time, there may have also been shift towards a more aggressive practice style at the authors' institution. Further study is needed to address this possibility.

Acute Disease↗
PubMed2007

Risk of local adverse events by gender following cardiac catheterization.

PURPOSE: To assess the reason for the relative high risk of local complications for women following cardiac catheterization by evaluating the associations between gender, sheath size, and local adverse outcomes following cardiac catheterization. METHODS: The data used in this study were obtained from a portion of the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR), which included 13 878 patients who underwent cardiac catheterization at one of 59 participating cardiac catheterization institutions throughout the United States during late 2003. Rates of serious local vascular adverse events were calculated by gender following cardiac catheterization, by type of vascular hemostasis used, stratified by arterial sheath size. RESULTS: Serious local vascular events were reported in 3.54% of patients, most commonly hematoma (2.00%). The relative risk for women of any vascular complication was 1.40 [95%CI = 1.17, 1.67, p = 0.0002]. A statistically significant relative risk for woman was evident when collagen plug devices or manual compression alone were used as the first method for hemostasis. The rate of vascular complications increased progressively with increasing sheath size, more so in women than in men. CONCLUSIONS: High relative risk for women of local vascular complications following cardiac catheterization was demonstrated with use of manual compression, as well as with collagen plug devices to control femoral artery bleeding. Large sheath size is associated with both a relatively high absolute risk and a high relative risk for women. Knowledge of this information should be considered by interventional cardiologists in making decisions on how to achieve hemostasis following cardiac catheterization.

Aortic Dissection↗