Fatal cardiac arrest during cardiac catheterization for angina pectoris: analysis of 10 necropsy patients.

Data on 10 patients with angina pectoris and fatal cardiac arrest during cardiac catheterization were analyzed to determine the circumstances of death and the severity and distribution of the coronary arterial narrowing. Nine patients died during attempted coronary angiography, and the remaining patient during right-sided cardiac catheterization. At least three of four major epicardial coronary arteries were narrowed 76 to 100 percent in cross-sectional area by atherosclerotic plaques in all 10 patients. Seven of these patients had this degree of narrowing of the left main coronary artery by plaque, and two additional patients had severe (more than 75 percent) narrowing of the left main coronary artery by thromboembolic material superimposed on small atherosclerotic plaques. Among 354 five mm long segments of the left main, left anterior descending, left circumflex and right coronary arteries in eight patients, the percent narrowing to various degrees in cross-sectional area by atherosclerotic plaques was as follows: 96 to 100 percent, 9; 76 to 95 percent, 49; 51 to 75 percent, 23; 26 to 50 percent, 13; and 0 to 25 percent, 6. With use of a scoring system of 1 to 4 for the amount of narrowing in each 5 mm segment (1 = 0-25 percent, 2 = 26 to 50 percent, 3 = 51 to 75 percent and 4 = 76 to 100 percent), the mean score per 5 mm segment for the group was 3.34. Thus, patients with angina pectoris who die during cardiac catheterization have particularly severe and diffuse coronary atherosclerosis and usually severe narrowing of the left main coronary artery.