Cardiac catheterization, originally performed only in hospital settings, is currently undertaken in hospital ambulatory and free-standing settings as well. Although use of the hospital ambulatory setting is accepted, questions have been raised about the safety and effectiveness of cardiac catheterization when performed in a free-standing setting. Critics have claimed that use of free-standing centers subjects patients to additional risk of complications without affording significant benefits. Proponents maintain that selected cardiac catheterization procedures can be performed in a free-standing setting without exposing patients to increased risk.

Available data on complication rates indicate that free-standing centers perform catheterizations with morbidity and mortality rates substantially lower than those reported in the literature for inpatient procedures. Although questions have been raised about the validity of using these data, they suggest that cardiac catheterization can be performed in a free – standing setting with acceptable safety and effectiveness.

Prepared by: Morgan N. Jackson, M.D., M.P.H.

Review of Available Information

Baird published the first series of outpatients undergoing cardiac catheterization in a free – standing setting (2). Patients were excluded if they had a history of recent myocardial infarction, severe congestive heart failure, arrhythmia or were hospitalized at the time catheterization was needed. The author used a brachial artery approach for all studies. After completion of the procedure, patients were discharged if they were stable following 1 hour of monitoring. Almost all patients with severe aortic stenosis or left main coronary artery disease, conditions which have been associated with a high risk for complications, were hospitalized after catheterization. Of the 620 patients in the study, one patient (0.16 percent) died after undergoing unsuccessful coronary artery bypass grafting for a left main coronary artery lesion. One patient (0.16 percent) developed a myocardial infarction and 4 patients (0.64 percent) experienced other complications the author described as major, including air embolism, aortic dissection, knotted catheter and ventricular tachycardia with arrest, successfully treated. In addition to these major complications (0.96 percent), brachial artery thrombosis occurred in 2 percent of patients, and complications identified as “management problems”, encountered with unspecified frequency, included transient arrhythmias, hypertension and angina pectoris. Baird concluded that his results encouraged use of ambulatory cardiac catheterization in the early detection of ischemic heart disease.