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Heart Disease and Stroke

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Older age, high blood pressure, and other factors increase the risk of complications from cardiac catheterization

People who are older than 60 years, suffer from high blood pressure, or have peripheral vascular disease are more apt to experience complications from cardiac catheterization (coronary angiography) than individuals without these problems. In this procedure, a contrast dye is injected into the heart via a catheter, which is threaded up the leg into the heart, in order to image heart problems. The risk of complications is further increased if the procedure is done on an emergency basis or at the same time as coronary angioplasty (insertion into the heart of a balloon catheter to open up a blocked artery).

While any one of these factors alone increases the risk of complications, the greater the number of risk factors a person has, the greater the overall risk of complications. In fact, the risk of complications may be as high as 10 percent in patients with more than three risk factors. Yet these high-risk patients are the ones most likely to benefit from the procedure, explains Gregg S. Meyer, M.D., M.Sc., of the Agency for Healthcare Research and Quality.

Dr. Meyer and his colleagues retrospectively reviewed the medical charts of 3,494 patients (most of whom were white men) who underwent cardiac catheterizations at 28 military facilities that performed many such operations from 1987 to 1989. They correlated potential risk factors with three types of complications: major (heart attack, stroke, or death within 24 hours of catheterization), minor (hemorrhage requiring transfusion, pseudoaneurysm, fistula, or femoral thrombosis), and any other type of complication.

Overall there were 59 major, 71 minor, and/or 122 complications of any type (since some patients experienced more than one complication). Complications were more likely in patients with hypertension (odds ratio, OR 1.8; 1 is equal odds) or peripheral vascular disease (OR 2.9), those older than 60 years (OR 2.1), and patients undergoing angioplasty (OR 6.0). There was a stepwise relationship between the number of risk factors present and the likelihood of any complication, with 1.4 percent, 4 percent, 6 percent, and 16 percent of patients with 0, 1, 2, and 3 to 4 risk factors, respectively, experiencing complications.

See "Complications from cardiac catheterization: Analysis of a military database," by Jeffrey L. Jackson, Major, M.C., U.S.A., Dr. Meyer, and Theron Pettit, Captain, M.C., U.S.A., in the April 2000 Military Medicine 165, pp. 298-301.

Reprints (AHRQ Publication No. 00-R037) are available from the AHRQ Publications Clearinghouse.

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