Recommended Tests for Pre-Catheterization Profile
A comprehensive pre-catheterization profile should include a medical history review, physical examination, electrocardiography, laboratory tests (complete blood count, coagulation studies, renal function, electrolytes), and appropriate cardiac imaging based on the patient's clinical presentation and risk factors. 1
Core Laboratory Tests
- Complete Blood Count (CBC): Essential for all patients to assess for anemia or thrombocytopenia that may increase procedural risk 1
- Coagulation Profile: Prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) to identify bleeding risk 1
- Renal Function Tests: Blood urea nitrogen (BUN) and creatinine to assess kidney function and contrast media risk 1
- Electrolytes: Particularly important for patients with heart disease or those on medications affecting electrolyte balance 1
- Blood Glucose: Random glucose testing for patients at risk of undiagnosed diabetes or with known diabetes 1
Cardiovascular Assessment
- 12-lead Electrocardiogram (ECG): Recommended for all patients to establish baseline cardiac status and identify arrhythmias or ischemic changes 1
- Cardiac Biomarkers: Baseline troponin levels should be obtained, especially for intermediate and high-risk patients 1
- Echocardiography: Indicated for patients with symptoms of heart failure, valvular disease, or unknown cardiac function 1, 2
Additional Testing Based on Clinical Presentation
- Chest Radiography: Reasonable for patients with cardiopulmonary symptoms or disease to assess cardiac size, pulmonary vasculature, and lung fields 1
- Cardiac Stress Testing: Consider for patients with poor functional capacity and elevated cardiac risk if results would change management 2
- Hemoglobin A1C: For patients with diabetes, only if results would alter perioperative management 1
Special Considerations
- Anticoagulation Status: Document current anticoagulant/antiplatelet medications and timing of last dose 1
- Allergies: Document contrast media allergies and other relevant allergies 1
- Hydration Status: Assess hydration status, especially for patients with renal impairment 1
Risk Assessment
- Cardiovascular Risk Stratification: Document risk factors for coronary artery disease and previous cardiac events 1, 2
- Functional Capacity Assessment: Evaluate using validated tools like the Duke Activity Status Index 1
- Frailty Assessment: Consider for elderly patients (≥70 years) using a validated tool 1
Common Pitfalls to Avoid
- Ordering unnecessary tests: Avoid routine testing without clinical indication, as this increases costs without improving outcomes 1
- Inadequate renal function assessment: Failure to identify renal impairment may lead to contrast-induced nephropathy 1
- Overlooking anticoagulation status: Not documenting or addressing anticoagulant use increases bleeding risk 1
- Insufficient cardiac risk stratification: Underestimating cardiac risk may lead to procedural complications 1
The European Society of Cardiology specifically recommends documenting pre-procedure troponin levels and obtaining follow-up levels at 24-48 hours post-procedure for intermediate and high-risk patients undergoing high-risk procedures to detect subclinical cardiac injury 1.