Pericatheterization risk factors in left main coronary artery stenosis.

Patients with left main (LM) coronary artery disease (CAD) have an unexplained high incidence of complications during diagnostic cardiac catheterization. This study identifies pericatheterization risk factors for major complications in patients with LM CAD (stenosis at least 50%). Complications were defined as ventricular fibrillation not related temporally to coronary injection, persistent angina, acute myocardial infarction, profound hypotension and death during or within 24 hours of catheterization. One hundred seven consecutive cases of LM CAD (11 with complications and 96 without) were reviewed with respect to variables potentially related to complications. Patients who had angina in the 24 hours before catheterization were at increased risk. Four of 13 patients with angina (31%) and 7 of 94 (7%) without angina had complications (p less than 0.05). Distance from the catheter tip to the lesion also was related to complications (9 of 38 [24%] with tip 6.0 mm or less from lesion and 2 of 65 [3%] with tip more than 6.0 mm from lesion, p less than 0.05). No relaxation was found between complications and New York Heart Association functional class, technique (femoral vs brachial), performance of ventriculography, number of coronary injections, amount of contrast injected, severity of LM stenosis, number of major arteries with 75% or more diameter stenosis, mean arterial pressure, left ventricular end-diastolic pressure and left ventricular ejection fraction.