From the Guidelines
Cardiac catheterization carries significant risks, including a mortality rate of approximately 0.1-0.2% for elective, stable adult patients, which increases for patients with severe heart disease, kidney dysfunction, or advanced age, as reported in the most recent guidelines 1. The most common complications of cardiac catheterization include:
- Bleeding or bruising at the insertion site, which occurs in about 5-10% of cases
- Blood vessel damage
- Allergic reactions to the contrast dye (1-3% of patients)
- Kidney damage from the contrast material (especially in those with pre-existing kidney disease)
- Blood clots that may lead to stroke or heart attack (less than 1%)
- Irregular heart rhythms
- Rarely, perforation of the heart or blood vessels (0.1-0.2%) Infection is possible but uncommon with proper sterile technique. Radiation exposure is another consideration, though the amounts used are carefully controlled. The experience and knowledge of the performing physician, as well as the experience and teamwork of laboratory personnel, are critical in minimizing the risks associated with cardiac catheterization, as emphasized in earlier guidelines 1. It is essential to carefully evaluate the risks and benefits of cardiac catheterization for each patient, taking into account their individual condition and medical history, to ensure that the procedure is performed safely and effectively. The frequency of major complications, such as myocardial infarction, thromboembolic accidents, and death, is related to several elements, including the underlying condition of the patient, as reported in the guidelines 1. For most patients, the risk of death from cardiac catheterization is very low, but this risk increases for patients with severe heart disease, kidney dysfunction, or advanced age, highlighting the need for careful patient selection and risk assessment, as discussed in the more recent guidelines 1.
From the Research
Risks Associated with Cardiac Catheterization
The risks associated with cardiac catheterization (cardiac cath) can be categorized into several types, including:
- Vascular complications, such as hematoma, pseudoaneurysm, arteriovenous fistula, peripheral artery occlusion and dissection, and retroperitoneal bleeding 2
- Cardiac complications, including emergency cardiac surgery 3
- Access-site complications, such as asymptomatic radial artery occlusion, nonocclusive radial artery injury, radial artery spasm, symptomatic radial arterial occlusion, pseudoaneurysm, and radial artery perforation 4
- Thromboembolic risks, which can be increased by stopping oral anticoagulants prior to the procedure 5
- Bleeding risks, which can be higher in patients with certain predisposing risk factors, as identified by a Cardiac Catheterization Risk Predictor Tool 6
Vascular Complications
Vascular complications are the most common type of complication after cardiac catheterization, with a reported incidence of less than 1% for diagnostic catheterizations and less than 3% for percutaneous coronary intervention 2. These complications can include:
- Hematoma
- Pseudoaneurysm
- Arteriovenous fistula
- Peripheral artery occlusion and dissection
- Retroperitoneal bleeding
Access-Site Complications
Access-site complications can occur with both transfemoral and transradial approaches, but the transradial approach has a markedly reduced incidence of major access-related complications 4. Some common complications of transradial access include:
- Asymptomatic radial artery occlusion
- Nonocclusive radial artery injury
- Radial artery spasm
- Symptomatic radial arterial occlusion
- Pseudoaneurysm
- Radial artery perforation
Prevention and Management of Complications
Prevention and management of complications can be achieved through various strategies, including:
- Avoiding multiple punctures
- Selection of smaller sheaths
- Gentle catheter manipulation
- Adequate anticoagulation
- Use of appropriate compression devices
- Avoiding prolonged high-pressure compression
- Careful observation for ominous signs, such as pain, numbness, and hematoma formation 4