From the Guidelines
The mortality rate associated with cardiac catheterization is approximately 0.14% overall, according to the most recent and highest quality evidence available 1. This rate can vary significantly based on patient characteristics, such as age, presence of coronary artery disease, congestive heart failure, and valvular heart disease.
- For patients less than 1 year of age, the mortality rate is significantly higher at 1.75% 1.
- In contrast, patients with one-vessel disease have a much lower mortality rate of 0.03% 1.
- The presence of congestive heart failure also impacts mortality, with NYHA functional class I or II patients having a mortality rate of 0.02%, while those with NYHA functional class IV have a significantly higher rate of 0.67% 1.
- Valvular heart disease patients have a mortality rate of 0.28%, with mitral valve disease patients having a slightly higher rate of 0.34% and aortic valve disease patients having a rate of 0.19% 1. It is essential to consider these factors when assessing the risk of cardiac catheterization for individual patients.
- Other high-risk characteristics, such as unstable angina, acute myocardial infarction, renal insufficiency, ventricular arrhythmias, cyanotic congenital heart disease, and congenital heart disease, should also be taken into account when evaluating the mortality risk associated with cardiac catheterization 1. The overall mortality rate of 0.14% highlights the relatively low risk of cardiac catheterization when performed by experienced operators in appropriate settings 1.
From the Research
Mortality Rate Associated with Cardiac Catheterization
- The mortality rate associated with cardiac catheterization is not directly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies mention that vascular access complications, contrast-induced nephropathy, and other adverse events can occur during or after cardiac catheterization, which may be associated with increased morbidity and mortality 2, 3, 4, 6.
- A study on vascular access complications found that severe complications, including those requiring blood transfusion or vascular repair, occurred in 1.2% of cases 3.
- Another study found that correlates of major vascular complications included age > 75 years and percutaneous coronary intervention (PCI) 4.
- A meta-analysis on clopidogrel loading doses found that a high loading dose (> 300 mg) significantly reduced early ischemic events in patients scheduled for percutaneous coronary intervention, without increasing major or minor bleeding 5.
- A study on a Vascular Complications Risk (VASCOR) score found that patients with a score ≥ 3 were at increased risk of complications, including access site hematoma, major and minor bleeding, and retroperitoneal hemorrhage 6.
Vascular Complications and Mortality
- Vascular complications, such as hematomas, pseudoaneurysms, and arteriovenous fistulas, can occur during or after cardiac catheterization and may be associated with increased morbidity and mortality 3, 4, 6.
- The use of closure devices, radial artery approach, and less aggressive anticoagulation regimens may help reduce the risk of vascular complications 3, 4.
- The VASCOR score can help predict vascular complications and identify patients at high risk 6.
Limitations and Future Studies
- The provided studies have limitations, including small sample sizes and retrospective designs 2, 3, 4, 5, 6.
- Further studies are needed to clarify the role of angiotensin-converting enzyme inhibitors in the development of contrast-induced nephropathy 2.
- Additional research is required to develop and validate risk scores for predicting vascular complications and mortality associated with cardiac catheterization 6.