COMPLICATIONS OF CORONARY ARTERIOGRAPHY FROM THE COLLABORATIVE STUDY OF CORONARY-ARTERY SURGERY (CASS)

Data were collected prospectively on 7553 patients undergoing coronary arteriography. The studies were performed at 13 clinics of the Collaborative Study of Coronary Artery Surgery (CASS) using brachial and femoral techniques. There were 8 deaths 0-24 h and 7 deaths 24-48 h after arteriography (2/1000). There were 15 non-fatal myocardial infarctions (MI) 0-24 h and 4 MI 24-48 h after arteriography (2.5/1000). Of 657 cases with left main [coronary artery] stenosis .gtoreq. 50%, 5 died and 3 had MI. Left main [coronary artery] disease increased risk of death by 6.8 times (P < 0.001). Other factors increasing risk were unstable angina, congestive heart failure, multiple premature ventricular contractions and hypertension. Of the 1187 patients studied from brachial artery technique, 6 died (0.51%) and 5 had MI (0.42%). In 6328 patients studied from femoral artery methods, 9 died (0.14%) and 14 had MI (0.22%). The brachial artery technique increased the risk of death 3.6 times compared with the femoral approach (P < 0.05). This result did not apply when analysis was restricted to laboratories with 80% or more brachial procedures. Risk was not altered by heparin. A prospective, multicenter analysis of complications reveals low risk of coronary arteriography but significant difference between 2 techniques.