Complications from Cardiac Catheterization: Analysis of a Military Database

Abstract

Cardiac catheterization is a common procedure in the United States. Our purpose was to assess possible risk factors for complications from cardiac catheterization. The Civilian External Peer Review Program database, which contains data on 3,494 cardiac catheterizations performed at 28 military facilities from 1987 to 1989, provided the patient population for this study. Of 360 abstracted clinical elements, 27 were selected by a panel of internists and cardiologists for evaluation as potential risk factors and were analyzed using logistic regression. Complications were analyzed within three categories: major (myocardial infarction, cerebral vascular accident, or death within 24 hours of catheterization); minor (hemorrhage requiring transfusion, pseudoaneurysm, fistula, or femoral thrombosis); and any. The mean age of the 3,494 patients was 56 years, and 75% of them were male; 85% were white, 10% were African-American, and 5% were other races. Complication rates were as follows: death (N = 13), 3.7/1,000; cerebral vascular accident (N = 16), 4.1/1,000; myocardial infarction (N = 22), 5.6/1,000; hemorrhage (N = 20), 5.1/1,000; fistula (N = 7), 0.3/1,000; and thrombosis (N = 15), 3.8/1,000. These were categorized as 59 major, 71 minor, or 122 any complications. Complications were more likely in patients with hypertension (odds ratio, 1.8; 95% confidence interval, 1.05-3.18), peripheral vascular disease (odds ratio, 2.9; 95% confidence interval, 1.1-8.7), age greater than 60 years (odds ratio, 2.1; 95% confidence interval, 1.2-3.8), and those undergoing angioplasty (odds ratio, 6.0; 95% confidence interval, 2.9-12.2). Hypertension, age greater than 60 years, peripheral vascular disease, and procedures either nonelective or involving angioplasty all independently increased the risk of complications. There was a "dose-response" relationship between risk and number of risk factors. The risk of a complication may be greater than 10% in patients with more than three risk factors.