Complications during and following cardiac catheterization

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Editors-In-Chief: Alexandra Almonacid M.D.[1] and Jeffrey J. Popma M.D.[2]


  • Patients at Increased Risk for Complications after Coronary Arteriography
    • Increased Medical Risk
      • Age >70 years
      • Complex congenital heart disease
      • Morbid obesity
      • General debility or cachexia
      • Uncontrolled glucose intolerance
      • Arterial oxygen desaturation
      • Severe chronic obstructive lung disease
      • Renal insufficiency with creatinine greater than 1.5mg/dl
    • Increased Cardiac Risk
      • Three-vessel coronary artery disease
      • Left main coronary artery disease
      • Functional class IV
      • Significant mitral or aortic valve disease or mechanical prosthesis
      • Ejection fraction less than 35%
      • High-risk exercise treadmill testing (hypotension or severe ischemia)
      • Pulmonary hypertension
      • Pulmonary artery wedge pressure greater than 25mmHg
    • Increased vascular Risk
      • Anticoagulation or bleeding diathesis
      • Uncontrolled systemic hypertension
      • Severe peripheral vascular disease
      • Recent stroke
      • Severe aortic insufficiency
    • Risk of Death
      • Death rates: 0.08 – 0.14%
      • Age : < 1 years and > 60 years
      • Class IV CHF 10 x higher than I or II
      • Left main 10 x higher than single vessel patients
      • Screening shots, minimize the views
      • LV dysfunction <30% 10x risk compared to >50%
      • Valvular heart disease
      • Severe non-cardiac disease
  • Major Complications
Predictors of Major Complications. Adapted from ACC/AHA guidelines for coronary angiography Scanlon et al:. JACC 33:1756, 1999
    • Major Complications
      • Mortality
      • Myocardial infarction
      • Cerebrovascular accident
      • Arrhythmias
      • Vascular complications
      • Contrast reaction
      • Hemodynamic complications
      • Perforation of heart chamber
  • Minor Complications
    • Uncommon (< 2 %).
    • Air embolus (0.1%)
    • Ventricular arrhythmias associated can be treated with lidocaine and direct-current cardioversion.
    • Cholesterol embolization
    • Nerve pain
    • Lactic acidosis may develop in diabetic patients taking metformin
  • Tips for Cardiac Catheterization
    • Be careful with the vascular puncture method
    • Always advance catheters over a guidewire around the aortic arch – keep the guidewire in place in the aorta during catheter exchanges
    • Flush catheters fully with saline to avoid bubbles within the manifold or the contrast line
    • Watch the arterial pressure at all time – never inject if the catheter has a damped pressure
    • Make certain the catheters are co-axial
    • Make certain to demonstrate evaluate each segment of each coronary artery



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