Coronary arteriography; prevention of complications in the high-risk patient
Although complications associated with coronary arteriography have decreased in most centers since 1970, they still occur in 1% to 2% of patients undergoing this invasive procedure. Major accidents include death (0.2%), nonfatal acute myocardial infarction (0.2%), arterial embolization to the central nervous system or peripheral arteries (0.1%), and arterial thrombosis or other types of local vascular injury (0.8% with the femoral approach and more than 1% with the brachial approach).
Systemic emboli and local vascular thrombosis or injury are technical complications related to the introduction of foreign material such as needles, guidewires, and catheters into the systemic circulation. They are also related, however, to factors such as vascular size, integrity, and vasoactivity as well as velocity of blood flow and coagulation factors. Thus, arterial thrombosis occurs frequently in younger persons and in women with or without clinical conditions leading to reduced cardiac output.
Death and nonfatal acute myocardial infarction are more closely related to the coronary anatomy and left ventricular function of the patient than to any other factor. These events are rare in individuals with normal coronary arteries who often represent 20% to 25% of the patient population undergoing coronary arteriography. Most patients have severe narrowing (70%) of two or three major coronary arteries usually associated with various degrees of left ventricular dysfunction. Significant left main coronary artery stenosis (50%), although variable, has been reported in 40% to 80% of patients who die or suffer an acute nonfatal myocardial infarction during or following coronary arteriography. Since left main coronary . . .