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Cardiac Catheterization - Risks & Limitations

What are the risks of cardiac catheterization?

Cardiac catheterization is a very safe procedure. Serious complications occur in 1% to 2% of all tests.4 Risks include bleeding around the insertion point, abnormal heartbeats, allergic reaction to the dyes used, infection, blood clots, and damage to arteries. You should tell your healthcare provider if you have had a reaction to X-ray dye, shellfish, or iodine in the past. The contrast dyes used in catheterization can also damage the kidneys in people with diabetes or previous signs of kidney damage.

Women are at a higher risk than men for bleeding problems at the catheter entry site. Removing the sheath early (with or without a device) and using lower doses of blood-thinning medications help lower the risk of bleeding problems. Some types of hemostatic sealing devices have been shown to reduce the risk of bleeding problems.5,6 When these devices are used to close the catheter entry site wound, the patient is able to get out of bed sooner and leave the hospital earlier than those treated without a device.

Cardiac catheterization involves radiation. The amount of radiation you are exposed to during cardiac diagnostic tests is considered safe. The benefits of the test far outweigh any potential risks, and the technicians are trained to minimize your radiation exposure. For information on radiation safety, see the National Institutes for Health Radiation Fact Sheet.

What are the limitations of cardiac catheterization?

Cardiac catheterization is considered the best test for diagnosing blockages in the arteries of the heart ( coronary arteries). If your angiogram is clear, it is very unlikely that you have any severe blockages. An angiogram visualizes fatty blockages on the lining of the coronary arteries, but it cannot tell which ones are likely to rupture and cause a heart attack. A blocked artery is one with fatty plaque buildup that closes off more than 50% of the artery. However, a bigger blockage does not necessarily mean a higher risk of having a heart attack. Most heart attacks occur when moderately sized fatty plaques burst and a blood clot develops, closing off the artery.

Are women less likely to be sent for cardiac catheterization than men?

A 1987 study of more than 80,000 heart disease patients showed that women were less likely to undergo cardiac catheterization than men.7 However, it is not clear whether this is a case of gender bias—meaning doctors are less likely to send women for testing because they mistakenly believe that heart disease is only a problem in men—or because women do not need this test as often as men. Up to 40% of women referred for cardiac catheterization do not have significant blockages in their arteries compared with 20% of men.2,3

More recent research finds that women are just as likely as men to receive this test if you take into account their age and risk factors.8,9 Even so, a study using videotapes of actors describing identical chest pain symptoms found that the race and sex of the actor influenced the doctors decision to refer them for cardiac catheterization. Black women were less likely than white men to be referred for cardiac catheterization.10

  1. Heart Disease and Stroke Statistics: 2004 Update. Dallas, Texas: American Heart Association; 2003.
  2. Kugelmass AD, Houser F, Simon A, et al. Diagnostic Results: Gender Continues to Make a Difference. J Am Coll Cardiol. 2001;37:497A.
  3. Roeters van Lennep JE, Zwinderman AH, Roeters van Lennep HW, et al. Gender differences in diagnosis and treatment of coronary artery disease from 1981 to 1997. No evidence for the Yentl syndrome. Eur Heart J. 2000;21:911-918.
  4. Bashore TM, Bates ER, Berger PB, et al. American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2001;37:2170-2214.
  5. Vaitkus PT. A meta-analysis of percutaneous vascular closure devices after diagnostic catheterization and percutaneous coronary intervention. J Invasive Cardiol. 2004;16:243-246.
  6. Koreny M, Riedmuller E, Nikfardjam M, Siostrzonek P, Mullner M. Arterial Puncture Closing Devices Compared With Standard Manual Compression After Cardiac Catheterization: Systematic Review and Meta-analysis. JAMA. 2004;291:350-357.
  7. Ayanian JZ, Epstein AM. Differences in the use of procedures between men and women hospitalized for coronary disease. N Engl J Med. 1991;325:221-225.
  8. Mark DB, Shaw LK, DeLong ER, Califf RM, Pryor DB. Absence of Sex Bias in the Referral of Patients for Cardiac Catheterization. N Engl J Med. 1994;330:1101-1106.
  9. Wong Y, Rodwell A, Dawkins S, Livesey SA, Simpson IA. Sex differences in investigation results and treatment in subjects referred for investigation of chest pain. Heart. 2001;85:149-152.
  10. Schulman KA, Berlin JA, Harless W, et al. The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization. N Engl J Med. 1999;340:618-626.


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