From the Guidelines
Cardiac catheterization complications can be categorized into major and minor adverse events, including cardiac structure perforation, injury, or compromise, new pericardial effusion, coronary obstruction, and coronary artery access difficulties, as defined by the Valve Academic Research Consortium 3 1.
Complications of Cardiac Catheterization
The complications of cardiac catheterization can occur during or after the procedure and may include:
- Cardiac structural complications, such as injury to the aortic annulus, left ventricle outflow tract, ventricular septum, left or right ventricle, atrial septum, left or right atrium, mitral valve apparatus, tricuspid valve apparatus, coronary artery, and coronary sinus 1
- Vascular complications, such as bleeding or hematoma at the access site, pseudoaneurysm, arteriovenous fistula, or retroperitoneal bleeding 1
- Contrast-induced nephropathy, which affects 2-25% of patients, particularly those with pre-existing kidney disease or diabetes 1
- Allergic reactions to contrast media, which happen in about 1% of procedures 1
- More serious but less frequent complications, such as stroke (0.1-0.4%), myocardial infarction (0.05-0.1%), arrhythmias, coronary artery dissection or perforation, and death (0.1-0.2%) 1
Risk Factors and Prevention Strategies
Risk factors for complications include advanced age, female gender, renal insufficiency, and complex procedures 1. Prevention strategies include:
- Proper patient selection
- Adequate hydration before and after the procedure
- Minimizing contrast volume
- Using radial rather than femoral access when possible
- Careful technique
- Post-procedure monitoring for several hours to detect and manage complications early 1 The overall risk-benefit ratio strongly favors performing cardiac catheterization when clinically indicated, with most complications being successfully managed if identified promptly 1.
From the Research
Complications of Cardiac Catheterization
The complications of cardiac catheterization (cardiac cath) can be categorized into several types, including:
- Vascular access complications, such as hematoma, pseudoaneurysm, arteriovenous fistula, peripheral artery occlusion and dissection, and retroperitoneal bleeding 2
- Bleeding complications, such as major and minor bleeding, and retroperitoneal hemorrhage 3
- Access site complications, such as hematoma, pseudoanurysm, and arteriovenous fistula 4
Risk Factors for Complications
Several risk factors have been identified for complications after cardiac catheterization, including:
- Use of anticoagulation therapy, such as warfarin or direct acting oral anticoagulant 5
- History of vascular complication after prior interventional cardiology procedure 3
- Female sex and age ≥60 years 3
- Use of large introducer sheaths (>6F) and percutaneous coronary intervention 3
Strategies for Decreasing Complications
Several strategies have been proposed to decrease vascular complications in diagnostic cardiac catheterization patients, including: