Complications of diagnostic cardiac catheterisation: results from a confidential inquiry into cardiac catheter complications.
OBJECTIVE
To estimate the frequency and nature of complications in patients undergoing diagnostic cardiac catheterisation and to assess time trends in complications since the introduction of a voluntary cooperative audit.


METHODS
Cardiac centres undertaking diagnostic cardiac catheterisation in England and Wales during the 10 years 1990-9 were invited to join the study. Each participating centre reported numbers of patients catheterised each month and details of complications and deaths as they occurred. Complication rates were calculated for the main diagnostic procedures and for each participating hospital and time trends in complications were examined.


RESULTS
41 cardiac centres contributed. 211 645 diagnostic procedures in adults and 7582 paediatric procedures were registered. The majority (87%) of diagnostic catheter studies in adults were left heart studies with coronary arteriography. The overall complication rate for adult procedures was 7.4/1000, with mortality at 0.7/1000; for paediatric procedures the complication rate was similar but mortality rather higher. Complication rates varied between centres but there was little association with caseload. Time trends across the decade showed both complication and mortality decreasing; from 9.5 to 5.8/1000 and from 1.4 to 0.4/1000, respectively.


CONCLUSIONS
Complication rates of diagnostic catheterisation are low but neither negligible nor irreducible. While voluntary audit of cardiac catheter complications is useful and inexpensive, there is a clear need to establish a formal reporting system in all cardiac catheter laboratories, with clear definitions of reportable complications.
West
R
R
Wales Heart Research Institute, University of Wales, Cardiff, UK. westrr@cardiff.ac.uk
Ellis
G
G
Brooks
N
N
D000328:Adult; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D004739:England / Q000453:epidemiology; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008485:Medical Audit; D015996:Survival Rate; D014852:Wales / Q000453:epidemiology