Complications of Coronary Arteriography from the Collaborative Study of Coronary Artery Surgery (CASS)

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Data were collected prospectively on 7553 consecutive patients undergoing coronary arteriog-raphy. The studies were performed at 13 clinics of the Collaborative Study of Coronary Artery Surgery (CASS) using brachial and femoral techniques.

There were eight deaths 0-24 hours and seven deaths 24-48 hours after arteriography (2/1000). There were 15 non-fatal myocardial infarctions (MIs) 0-24 hours and four MIs 24-48 hours after arteriography (2.5/1000). Of 657 cases with left main stenosis 50%, five died and three had MI. Left main disease in-creased risk of desth by 6.8 times (p < 0.001). Other factors increasing risk were unstable angina, congestive heart failure, multiple prematurs ventricular contractions, and hypertension.

Of the 1187 patients studied fr;om the brachial artery, six died (0.51%) and five had MIs (0.42%). In 6328 patients studied from the femoral artery, nine died (0.14%) and 14 had MIs (0.22%). The brachial artery technique increased the risk of death 3.6 times compared with the femoral approach (p < 0.05). This result did not apply when analysis was yestricted to laboratories with 80% or more brachial procedures. Risk was not altered by heparin. I'hus, a prospective, multicenter analysis of complications reveals low risk of coronary arteriography but significant difference between two techniques.

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