From the Guidelines
Cardiac catheterization does not significantly affect mortality in stable patients, with an overall mortality risk of approximately 0.1% for diagnostic procedures, as reported in studies such as 1 and 1.
Mortality Risk Factors
The mortality risk associated with cardiac catheterization is influenced by various factors, including:
- Patient characteristics, such as age, with higher risks observed in neonates and elderly patients 1
- Underlying medical conditions, including severe coronary artery disease, congestive heart failure, and valvular heart disease 1
- Presence of high-risk characteristics, such as unstable angina, acute myocardial infarction, renal insufficiency, and ventricular arrhythmias 1
Procedure-Related Risks
The procedure itself carries risks, including:
- Bleeding and vascular injury
- Stroke and contrast-induced nephropathy
- These risks are increased in patients with severe comorbidities, advanced age, or when performed emergently 1
Mortality Benefit
The mortality benefit of cardiac catheterization is most pronounced when performed promptly in acute coronary syndromes, such as ST-elevation myocardial infarction (STEMI), ideally within 90 minutes of first medical contact, as it facilitates immediate revascularization and restores blood flow to ischemic myocardium 1.
Clinical Considerations
When evaluating the risks and benefits of cardiac catheterization, clinicians should consider the individual patient's characteristics, underlying medical conditions, and the potential risks associated with the procedure. The decision to perform cardiac catheterization should be made on a case-by-case basis, taking into account the latest evidence and guidelines, such as those reported in 1, 1, and 1.
From the Research
Cardiac Catheterization and Mortality
- Cardiac catheterization is a medical procedure that can have a risk of mortality, particularly in patients with advanced cardiac disease 2, 3.
- The mortality rate for cardiac catheterization has been reported to be around 0.10% to 0.071% in different studies 2, 3.
- Certain patient characteristics, such as left main coronary artery disease, ejection fraction less than 30%, NYHA class III or IV, age over 60 years, and three-vessel disease, have been identified as risk factors for increased mortality 2, 3.
Risk Factors for Mortality
- Left main coronary disease is a significant risk factor for mortality, with a reported incidence of 0.7% to 0.94% 2, 3.
- Catheter-induced trauma, such as dissection of the left main coronary artery, is a common mechanism of death during diagnostic catheterization 3.
- Other risk factors, such as history of congestive heart failure, ST depression on the resting ECG, and a drop in systolic blood pressure during exercise, have also been identified as predictors of cardiovascular death 4.
Long-term Outcomes
- Patients with angina and multivessel coronary artery disease who are treated with medical management after catheterization have poor long-term outcomes, with high rates of death, cardiac rehospitalization, and late revascularization 5.
- The cumulative rate of death, myocardial infarction, late revascularization, or cardiac rehospitalization can occur in up to 76% of patients at 5 years 5.
Quality Improvement
- Morbidity and mortality conferences are an important component of cardiac catheterization laboratory quality improvement programs, and can help identify areas for improvement and reduce mortality 6.