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. 1996 Jul;76(1):76–78. doi: 10.1136/hrt.76.1.76

Cardiac catheter complications related to left main stem disease.

J D Kovac 1, D P de Bono 1
PMCID: PMC484431  PMID: 8774333

Abstract

OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies. RESULTS: The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions. CONCLUSIONS: The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting.

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Selected References

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  1. Aursnes I., Benestad A. M., Sivertssen E., Skjaeggestad O., Grønseth K. Degree of coronary artery disease predicted by exercise testing. J Intern Med. 1991 Apr;229(4):325–330. doi: 10.1111/j.1365-2796.1991.tb00354.x. [DOI] [PubMed] [Google Scholar]
  2. Boehrer J. D., Lange R. A., Willard J. E., Hillis L. D. Markedly increased periprocedure mortality of cardiac catheterization in patients with severe narrowing of the left main coronary artery. Am J Cardiol. 1992 Dec 1;70(18):1388–1390. doi: 10.1016/0002-9149(92)90286-8. [DOI] [PubMed] [Google Scholar]
  3. Bogaert J., Duerinckx A. J., Baert A. L. Coronary MR angiography: a review. J Belge Radiol. 1994 Dec;77(6):255–261. [PubMed] [Google Scholar]
  4. Duerinckx A. J., Urman M. K. Two-dimensional coronary MR angiography: analysis of initial clinical results. Radiology. 1994 Dec;193(3):731–738. doi: 10.1148/radiology.193.3.7972815. [DOI] [PubMed] [Google Scholar]
  5. Elder A. T., Shaw T. R., Turnbull C. M., Starkey I. R. Elderly and younger patients selected to undergo coronary angiography. BMJ. 1991 Oct 19;303(6808):950–953. doi: 10.1136/bmj.303.6808.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hubbard B. L., Gibbons R. J., Lapeyre A. C., 3rd, Zinsmeister A. R., Clements I. P. Identification of severe coronary artery disease using simple clinical parameters. Arch Intern Med. 1992 Feb;152(2):309–312. [PubMed] [Google Scholar]
  7. Iga K., Gohma I., Hori K. Regression of the left main trunk lesion by steroid administration in Takayasu's aortitis. Chest. 1991 Feb;99(2):508–510. doi: 10.1378/chest.99.2.508. [DOI] [PubMed] [Google Scholar]
  8. Janek B., Málek I., Ouhrabková R., Firt P., Frídl P., Horák J., Kovác J., Stanek V. Left main coronary artery stenosis. Cor Vasa. 1992;34(2):123–134. [PubMed] [Google Scholar]
  9. Koh K. K., Hwang H. K., Kim P. G., Lee S. H., Cho S. K., Kim S. S., Han J. J., Lee Y. T., Park P. W., Yoon D. H. Isolated left main coronary ostial stenosis in Oriental people: operative, histopathologic and clinical findings in six patients. J Am Coll Cardiol. 1993 Feb;21(2):369–373. doi: 10.1016/0735-1097(93)90677-s. [DOI] [PubMed] [Google Scholar]
  10. Miranda C. P., Lehmann K. G., Froelicher V. F. Correlation between resting ST segment depression, exercise testing, coronary angiography, and long-term prognosis. Am Heart J. 1991 Dec;122(6):1617–1628. doi: 10.1016/0002-8703(91)90279-q. [DOI] [PubMed] [Google Scholar]
  11. Nakashima H., Takahara A., Yoshioka M., Suzuki S., Mori H., Oku Y. [A case of left coronary ostial obstruction due to syphilitic aortitis]. Kokyu To Junkan. 1991 Aug;39(8):831–835. [PubMed] [Google Scholar]
  12. Nishimura R. A., Higano S. T., Holmes D. R., Jr Use of intracoronary ultrasound imaging for assessing left main coronary artery disease. Mayo Clin Proc. 1993 Feb;68(2):134–140. doi: 10.1016/s0025-6196(12)60160-8. [DOI] [PubMed] [Google Scholar]
  13. Okayama H., Watanabe K., Abe M., Matsuoka H., Sumimoto T., Sekiya M., Hamada M., Hiwada K. [A case of middle aged women with isolated left coronary ostial stenosis]. Kokyu To Junkan. 1992 Sep;40(9):923–926. [PubMed] [Google Scholar]
  14. Paschal C. B., Haacke E. M., Adler L. P. Three-dimensional MR imaging of the coronary arteries: preliminary clinical experience. J Magn Reson Imaging. 1993 May-Jun;3(3):491–500. doi: 10.1002/jmri.1880030311. [DOI] [PubMed] [Google Scholar]
  15. Sathe S., Sebastian M., Vohra J., Valentine P. Bail-out stenting for left main coronary artery occlusion following diagnostic angiography. Cathet Cardiovasc Diagn. 1994 Jan;31(1):70–72. doi: 10.1002/ccd.1810310114. [DOI] [PubMed] [Google Scholar]
  16. Sathe S., Sebastian M., Vohra J., Valentine P. Bail-out stenting for left main coronary artery occlusion following diagnostic angiography. Cathet Cardiovasc Diagn. 1994 Jan;31(1):70–72. doi: 10.1002/ccd.1810310114. [DOI] [PubMed] [Google Scholar]
  17. Seguchi M., Hino Y., Aiba S., Yasukohchi S., Momma K., Takao A., Endo M. Ostial stenosis of the left coronary artery as a sole clinical manifestation of Takayasu's arteritis: a possible cause of unexpected sudden death. Heart Vessels. 1990;5(3):188–191. doi: 10.1007/BF02059914. [DOI] [PubMed] [Google Scholar]
  18. Topaz O., Warner M., Lanter P., Soffer A., Burns C., DiSciascio G., Cowley M. J., Vetrovec G. W. Isolated significant left main coronary artery stenosis: angiographic, hemodynamic, and clinical findings in 16 patients. Am Heart J. 1991 Nov;122(5):1308–1314. doi: 10.1016/0002-8703(91)90570-8. [DOI] [PubMed] [Google Scholar]
  19. Tönz M., Laske A., Niederhäuser U., Kaufmann U., Pasic M., von Segesser L. K., Turina M. Die koronare Hauptstammstenose: eine bleibende Herausforderung. Schweiz Med Wochenschr. 1992 Oct 3;122(40):1479–1482. [PubMed] [Google Scholar]
  20. Vigneswaran W. T., Sapsford R. N., Stanbridge R. D. Disease of the left main coronary artery: early surgical results and their association with carotid artery stenosis. Br Heart J. 1993 Oct;70(4):342–345. doi: 10.1136/hrt.70.4.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Yamagishi M., Yasu T., Ohara K., Kuro M., Miyatake K. Detection of coronary blood flow associated with left main coronary artery stenosis by transesophageal Doppler color flow echocardiography. J Am Coll Cardiol. 1991 Jan;17(1):87–93. doi: 10.1016/0735-1097(91)90708-h. [DOI] [PubMed] [Google Scholar]
  22. Yamanaka O., Hobbs R. E. Solitary ostial coronary artery stenosis. Jpn Circ J. 1993 May;57(5):404–410. doi: 10.1253/jcj.57.404. [DOI] [PubMed] [Google Scholar]
  23. de Bono D. Complications of diagnostic cardiac catheterisation: results from 34,041 patients in the United Kingdom confidential enquiry into cardiac catheter complications. The Joint Audit Committee of the British Cardiac Society and Royal College of Physicians of London. Br Heart J. 1993 Sep;70(3):297–300. doi: 10.1136/hrt.70.3.297. [DOI] [PMC free article] [PubMed] [Google Scholar]

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