[Iatrogenic pathology in coronary intensive care units. Results of a prospective survey on 802 patients].

Iatrogenic disease in the coronary care unit was detected and analysed using a grid over a 17.5 month period (16.09.82 to 25.02.84). The cases of 802 patients, mean age 65.8 years, predominantly male (56.6%) were examined. Minor or minimal pathology in which the causal relationship was conditional or doubtful according to Karch's criteria was excluded. Only those conditions, moderate, severe or even lethal, specific or not to this type of unit, requiring specialised hospital care and in which the causal relationship could be adequately established were retained. Iatrogenic pathology was common: 11.84% of admissions. This group of 95 patients did not differ significantly from a control group with respect to age [average 4 years older (NS)] or mortality. However, there was a clear cut female predominance (68%, p. less than 0.01) and a different distribution of the organic pathology (p less than 0.001). The iatrogenic disease developed before hospital admission in 40% of patients and during hospitalisation in 60% of patients. It increased the duration of the patient's stay by half (2.77 days). Nearly a quarter of these patients had two or more types of iatrogenic disease. The undesirable effects of drugs were mainly bradycardia (44 cases), tachycardia (11 cases), haemodynamic changes, vascular, renal, gastrointestinal, metabolic and endocrine complications. Twenty-one complications of medical procedures and 13 of surgical procedures were also noted. This study, the first to have been performed in a Coronary Care Unit to the author's knowledge, confirms the high incidence of iatrogenic pathology. This fact should be born in mind before taking any therapeutic decision or before performing invasive diagnostic investigations.