Interventional cardiology consists of several related procedures that are performed in the coronary, peripheral, and cerebral vascular systems, as well as the central aorta, the cardiac valves, and the structural units (parenchyma) of the heart itself. Almost all of the procedures are performed under radiographic fluoroscopic guidance in a cardiac catheterization laboratory (cath lab), or sometimes a “hybrid” laboratory that can also function as a surgical operating room. Often the fluoroscopic imaging is complemented with intravascular ultrasound, transthoracic or intracardiac echocardiography, and rotational computed tomographic angiography (CTA). Thus, the modern cath lab is a complex, highly technologically sophisticated facility where both patients with chronic, stable conditions as well as patients with life-threatening illnesses are evaluated and treated. Therefore, it is essential to have an active quality assurance and improvement (QA/QI) program in place. This program will need to consider all aspects of the risks encountered by patients undergoing procedures in the cath lab, as well as by staff working there. This will of course include radiation risk and methodologies for reducing it. However, radiation risk is an extensive subject on its own and will not be covered in this chapter.
GENERAL COMPLICATIONS FROM INVASIVE CARDIOVASCULAR PROCEDURES
With the tremendous growth and increased experience of invasive cardiovascular training programs, paralleling the general overall growth in cardiac catheterization as a common diagnostic procedure, there has been a decline in the risks of undergoing an invasive procedure. Complication rates with general diagnostic catheterization and angiography are quite low. Major adverse cardiovascular events (MACE) such as death, stroke, myocardial infarction (MI), and emergency surgery typically occur in <0.1% of diagnostic procedures.1 However, for cardiovascular procedures where therapeutic intervention is attempted, the story is very different (Tables 73-1 and 73-2). Complication rates may be much higher and may be widely different between institutions.
Table 73-1In-Hospital and Short-Term Complications Following Elective Percutaneous Coronary Intervention ||Download (.pdf) Table 73-1 In-Hospital and Short-Term Complications Following Elective Percutaneous Coronary Intervention
|Study Name ||Year of Publication ||Death (%) ||MI (%) ||CABG (%) ||Neuro (%) ||Major Vascular (%) ||Bleeding (%) |
|ACC-NCDR (registry) ||2002 ||1.4 ||0.4 ||1.9 ||— ||— ||— |
|SIRIUS (RCT) ||2003 ||0.09 ||1.9 ||0 ||— ||— ||— |
|RESEARCH (registry) ||2004 ||1.6 ||0.8 ||1.0 ||— ||— ||— |
|SYNERGY (RCT) ||2004 ||0.47 ||5.7 ||0.3 ||0.9 ||— ||~2.2 |
|ACUITY (RCT) ||2006 ||1.4 ||5.0 ||— ||<0.1 ||0.5 ||5.5 |
|NHLBI DR (registry) ||2007 ||— ||— ||— ||— ||1.8 ||— |
|NHLBI DR (registry) ||2009 ||0.2 ||2.0 ||0.3 ||— ||6.0 ||— |
|ACC-NCDR (registry) ||2009 ||— ||— ||— ||0.22 ||— ||— |
|ACC-NCDR (registry) ||2009 ||— ||— ||— ||— ||— ||2.4 |
|EVENT (registry) ||2009 ||0.1 ||6.5 ||— ||— ||— ||— |