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Complications of Cardiac Catheterization Versus Coronary Angiography

      To the Editor: Questions have been raised about the frequency of complications of cardiac catheterization stated in our article on surgical aortic stenosis, which was published in the February 1996 issue of the Mayo Clinic Proceedings (pages 141 to 149). We think that the presentation of these events could be misinterpreted and thus deserves clarification. As we indicated in the article, the morbidity related to cardiac catheterization was low. We also indicated that the complications were more frequent among patients who underwent hemodynamic catheterization (7%) than among those who underwent coronary angiography only (4%). The percentages reported in the article, however, pertain to all the complications that occurred; these included hematomas, renal failure, and allergic reaction in addition to the complications specifically cited in the report-pulmonary edema, cardiogenic shock, and ventricular arrhythmias. The breakdown of all complications of hemodynamic catheterization versus those of coronary angiography only is as follows: ventricular arrhythmia, 1 vs 1; ischemia, 1 vs 0; hypotension, 1 vs 0; pulmonary edema, 1 vs 1; hematoma, 6 vs 7; renal failure, 1 vs 0; and allergic reaction, 0 vs 1. Thus, the frequency of life-threatening complications in this series was very low, and the results of the study remain unchanged.
      In addition, we wish to reemphasize that our study was not designed to address the issue of catheterization-related morbidity and mortality of aortic stenosis. Our series does not represent the comprehensive experience of our catheterization laboratory relative to aortic stenosis; in particular, nonsurgical patients, whose baseline characteristics and outcome may vary greatly in comparison with those of a surgical series, were not included. Thus, generalizing the figures stated in this series to all patients with aortic stenosis undergoing cardiac catheterization would be erroneous.