Kennedy J W, Baxley W A, Bunnel I L, Gensini G G, Messer J V, Mudd J G, Noto T J, Paulin S, Pichard A D, Sheldon W C, Cohen M
Cathet Cardiovasc Diagn. 1982;8(4):323-40. doi: 10.1002/ccd.1810080402.
During a 14-month period, 75 deaths occurring in relation to 53,581 cardiac catheterizations were consecutively and prospectively reported to the Registry Committee of the Society for Cardiac Angiography. Three of the patients died several days after their catheterization from an unrelated cause and are excluded from this analysis. There were 21 patients (group I) who arrived at the laboratory in extremis and whose deaths were expected irrespective of the catheterization. Most of these patients suffered from recent myocardial infarctions and cardiogenic shock, or had complex congenital malformations. In 35 patients (group II), a cardiovascular complication occurring during the catheterization resulted in death. In 16 patients (group III) catheterization seemed uneventful, but death occurred suddenly 10 min to 10 h after the procedure. Of these 16 patients, eight had left main coronary artery obstruction greater than or equal to 90%, five had three-vessel disease all with 90% obstructions, one had 2-vessel disease both with 90% obstructions, and who had critical aortic stenosis. The 51 unexpected deaths (groups II and III) were considered to be causally related to the procedure, a mortality rate of 0.10%. Subsets with an increased mortality rate (M), were patients with: a) left main disease greater than 50% (M = 0.94%); b) ejection fraction less than 30% (M = 0.54%); c) NYHA class III or IV (m = 0.24%); d) age over 60 years (M = 0.23%); or e) three-vessel disease (M = 0.13%). In conclusion, catheterization related mortality occurs mostly in patients with far advanced cardiac disease. Nearly 1/3 of the unexpected deaths occurred suddenly after a seemingly uneventful procedure. Close monitoring after catheterization of patients with similar characteristics (left main disease greater than or equal to 90%, or three-vessel disease all greater than or equal to 90%) might disclose avenues for reducing mortality occurring after catheterization.
在14个月的时间里，与53581例心脏导管插入术相关的75例死亡病例被连续且前瞻性地报告给了心脏血管造影学会注册委员会。其中3例患者在导管插入术后数天因无关原因死亡，被排除在本分析之外。有21例患者（第一组）在病情极度危急时被送到实验室，无论是否进行导管插入术，他们的死亡都在意料之中。这些患者大多患有近期心肌梗死和心源性休克，或有复杂的先天性畸形。在35例患者（第二组）中，导管插入术中发生的心血管并发症导致了死亡。在16例患者（第三组）中，导管插入术似乎顺利，但术后10分钟至10小时突然死亡。在这16例患者中，8例左主干冠状动脉阻塞大于或等于90%，5例三支血管病变且阻塞均达90%，1例两支血管病变且阻塞均达90%，还有1例患有严重主动脉瓣狭窄。51例意外死亡（第二组和第三组）被认为与该手术有因果关系，死亡率为0.10%。死亡率增加的亚组（M）包括：a）左主干病变大于50%（M = 0.94%）；b）射血分数小于30%（M = 0.54%）；c）纽约心脏协会（NYHA）心功能分级III或IV级（M = 0.24%）；d）年龄超过60岁（M = 0.23%）；或e）三支血管病变（M = 0.13%）。总之，与导管插入术相关的死亡率主要发生在患有晚期心脏病的患者中。近1/3的意外死亡发生在看似顺利的手术后突然死亡。对具有类似特征（左主干病变大于或等于90%，或三支血管病变均大于或等于90%）的患者在导管插入术后进行密切监测，可能会找到降低导管插入术后死亡率的方法。
