With the advancement of coronary arterial surgery over the last decade, cardiac catheterization and coronary angiography have become frequently performed diagnostic procedures. Previously, the usual policy was to admit the patient to the hospital one day prior to the study, followed by overnight observation after the cardiac catheterization. The increase in the number of studies performed and the ever-escalating cost of hospitalization have prompted some institutions to evaluate the safety of outpatient cardiac catheterization and coronary angiography. These studies examine the rates of complications in relatively small numbers of outpatients and do not report on the procedure-related complications of inpatient cardiac catheterization in the same institutions. We initiated this study to compare rates of complications of outpatient and inpatient cardiac catheterization when performed in the same institution by the same group of cardiologists.
Materials and Methods
From February 1981 to November 1983, there were 676 procedures for cardiac catheterization and coronary angiography performed on an outpatient basis by a group of five cardiologists. The control group consisted of 1,106 patients who had cardiac catheterization performed on an inpatient basis by the same group of cardiologists during 1983.
The inpatient group included patients who, in spite of optimal medical management, were in the New York Heart Associations (NYHA) functional class 4 and patients who preferred to be hospitalized for the procedure. Advanced age, the likelihood of left main coronary arterial disease or triple-vessel disease, and history of recent myocardial infarction were not considered contraindications to outpatient cardiac catheterization.
Outpatients studied were asked to fast overnight. They were admitted to an observation unit, usually one hour before the procedure. After the cardiac catheterization, they were returned to the same unit, where they were monitored for around two hours, and then discharged. On the following day, they were seen in the outpatient clinic by the cardiologist who performed the study. The results of the study were discussed, and the patients were checked for procedure-related complications. Doctors and medical workers in general should be profesionals. Only in such a case the patients will receive the well-qualified help. To know more about various aspects of medical life – More info about diseases and hot news – Canadian health&care Mall – canadianhealthnetmall.com.
The medical and cardiac catheterization records were analyzed for final diagnoses and clinical data including functional classification and complications related to cardiac catheterization. Significant coronary arterial disease was interpreted as more than 50 percent narrowing in the left main coronary artery or more than 75 percent narrowing in any other major coronary arterial segment.
Complications were divided into major and minor. Major complications included the following: death occurring within 24 hours after the procedure; death following emergency surgery; myocardial infarction occurring within 24 hours after the procedure; pulmonary embolus occurring within 24 hours after the procedure; perforation or dissection of a major vessel or chamber; life-threatening dysrhythmias (ventricular tachycardia; ventricular fibrillation; asystole); and neurologic damage lasting longer than 24 hours. Minor complications included the following: thrombus or hemorrhage requiring surgical correction; hypotension requiring therapy for more than one hour; prolonged angina requiring hospitalization in the coronary care unit; and pyrogenic reaction (a temperature greater than 39.4°C [103°F] and shaking chills within 24 hours of the catheterization).
Outpatients were divided into higher and lower risk groups according to the diagnosis after catheterization. The higher risk group was comprised of patients who, from previous observations, were found to have a higher rate of cardiac catheterization-related complications (left main coronary arterial disease; triple-vessel coronary disease; left ventricular ejection fraction less than 30 percent). In addition, we elected to include patients with recent myocardial infarction (less than two months before the procedure) in this higher risk group. The lower risk group was comprised of the remaining patients studied on an outpatient basis. Financial data were retrieved from a computerized billing system.
The x2 test was used for the comparison of two or more proportions in independent samples.