The Risk and Cost of Coronary Angiography

It may be reasonable from an economic point of view to expect 300 angiographic cases per year in existing laboratories, but there is no economic justification for requiring a certain number of cardiac studies per year.

Abstract

The risk of coronary angiography has been decreasing since development of the procedure 19 years ago. Deaths resulting from angiography now occur only in high-risk clinical circumstances. Whether a certain case load per angiographer or laboratory is necessary for adequate safety is still a question. Even though little available data exist on the relationship of case loads to risk, the National Guidelines for Health Planning now require 300 cardiac catheterizations per laboratory per year and forbid development of new laboratories in hospitals without heart surgery programs. Data collected from all 16 laboratories in Washington showed 26 deaths (0.19%) during 14,050 coronary angiograms. Eighteen of those who died had a severe left main coronary obstruction, and three had severe triple-vessel disease. There were 18 myocardial infarctions (0.13%) and nine strokes (0.06%). The risks in hospitals without cardiac surgery programs and in hospitals performing fewer than 200 cases per year were no higher than in the other hospitals studied. The National Guidelines should be reevaluated before they are used to change the existing pattern of health care.