Outpatient coronary angiography: Indications, safety, and complication rates

Abstract

In the years since the introduction of outpatient cardiac catheterization and coronary angiography, the indications for the use of these procedures have expanded rapidly with advancements in surgical and endovascular procedures. The safety of outpatient coronary angiography has been well established, comparing very favorably with that of inpatient procedures. At present, a variety of different outpatient facilities exist. Catheterization laboratories may adjoin a hospital or be free-standing; the safety and success of procedures performed in mobile cardiac catheterization laboratories has also been described. There are a variety of access techniques for cardiac catheterization in use today, and there are many types and sizes of catheters available. Miniaturization of equipment has reduced complications and allowed early ambulation and discharge from outpatient laboratories. In addition, the development and refinement of catheters and techniques for achieving hemostasis may allow further reductions in patient stay and complications. The complication rates of outpatient cardiac catheterization and coronary angiography are, in fact, quite low--in some cases, lower complication rates are seen in the outpatient population than in the inpatient population. Although this is certainly related in part to the fact that outpatients generally have more stable disease, it is clear that careful equipment choices, proper technique, and adequate monitoring have contributed to the success of these important outpatient procedures.

The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions

“…2 Atherosclerotic thromboembolism due to catheter manipulation, thrombus formation in the catheter lumen, and air embolism are the main causes of symptomatic or asymptomatic thromboembolic events. 1 Silent embolic cerebral infarction (SECI) is defined as an embolic origin brain lesion, which is the result of vascular occlusion diagnosed incidentally by magnetic resonance imaging (MRI) or computed tomography (CT) in otherwise healthy participants or at autopsy. 3 Retrospective studies demonstrated that SECI was detected in 13% to 22% of cases undergoing diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI).…”

“…As an invasive diagnostic and therapeutic procedure, there are important periprocedural complications. 1 One of the well-known serious complication category is thromboembolic events including cerebrovascular events. 2 Atherosclerotic thromboembolism due to catheter manipulation, thrombus formation in the catheter lumen, and air embolism are the main causes of symptomatic or asymptomatic thromboembolic events.…”

“…2 Atherosclerotic thromboembolism due to catheter manipulation, thrombus formation in the catheter lumen, and air embolism are the main causes of symptomatic or asymptomatic thromboembolic events. 1…”

The Safety of Performing Diagnostic Cardiac Catheterizations in a Mobile Catheterization Laboratory at Primary Care Hospitals

“…In a review of the literature, the safety of performing diagnostic studies in a mobile laboratory in rural areas has been described by only very few groups. [1][2][3] Thus, our objective was to determine the safety of performing cardiac catheterizations, including left and right heart catheterizations, post-CABG catheterizations, and catheterization of patients with valvular or congenital heart disease, in a mobile laboratory at small community hospitals, provided that emergency helicopter and/or paramedic ambulance service to a tertiary hospital was available.…”

Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions

“…Although cardiac catheterization is considered a safe invasive procedure, 1 there is always concern about periprocedural complications, including cerebral embolic events. Stroke, determined as a neurological deficit of new onset, is a rare complication (0.11%-0.38%) in patients undergoing cardiac catheterization, but asymptomatic cerebral infarction seems to occur more frequently (12%-23%).…”