Complications of coronary arteriography from the Collaborative Study of Coronary Artery Surgery (CASS)

Data were collected prospectively on 7553 consecutive patients undergoing coronary arteriography. The studies were performed at 13 clinics of the Collaborative Study of Coronary Artery Surgery using brachial and femoral techniques. There were eight deaths 0-24 hours and seven deaths 24-48 hours after arteriography (2/1000). There were 15 non-fatal myocardial infarctions (MIs) 0-24 hours and four MIs 24-48 hours after arteriography (2.5/1000). Of 657 cases with left main stenosis ≥50%, five died and three had MI. Left main 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 the brachial artery, six died (0.51%) and five had MIs (0.42%). In 6328 patients studied from the femoral artery, nine died (0.14%) and 14 had MIs (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. Thus, a prospective, multicenter analysis of complication reveals low risk of coronary arteriography but significant difference between two techniques.