Prevention of Complications of Coronary Arteriography

STARTLING FACTS about the incidence of complications of coronary arteriography in the U. S. during the years 1970 and 1971 emerge from the study reported by Adams et al. in the September 1973 issue of Circulation.The following findings seen nationally are most significant.(1) Death or the serious nonfatal complications of myocardial infarction and/or cerebral embolus occur in an unacceptable 1.5% of all patients examined; the occurrence is ten times higher in institutions performing fewer than 100 examinations/year than in those doing more than 400/year.Reported death rates vary more than one hundred fold, from 0.05% to 8%.1, 2 (2) The serious complica- tions, primarily thrombotic, occur eight times more frequently when the percutaneous transfemoral approach is used.(3) Fifty-five percent of labora- tories using a femoral method do fewer than 50 cases/year.As volume increases, the complication disparity between the brachial and the femoral approach dramatically narrows to near equality.The reported complication rates are unacceptably high.Two clearly evident factors emerge: (1) the competence of the operator (training and main-