Coronary angiography Review of 1500 consecutive cases

Fifteen hundred coronary angiograms have been performed by the staff of Harefield Hospital since 1970. Only 2 deaths have occurred in the last 1000 consecutive cases though there were 5 in the first 500 cases. This drop in the mortality is ascribed to careful attention to detail and better training of the operators. It is concluded that the Judkin's method of coronary angiography in trained hands is a safe method of in-vestigation but that because of the very serious potential dangers it is unjustifiable for new units to start unless there is a fully experienced investigator in charge. With the advent of successful revascularization of blocked and narrowed coronary arteries, using venous bypass grafts from the aorta, the demand for coronary angiography has risen rapidly during the past 5 years. At Harefield 25 arteriograms were performed in 1970 but 615 in 1975 (Fig. 1) though circumstances beyond our control reduced the number conspicuously at the end of the last year. Information about the safety of this examination is, therefore, important. Emanuel (1975) circularized 50 British centres undertaking coronary angiography in 1973. Of the 46 who replied, only 9 knew the mortality rate for their institution; the highest was up to 0-6 per cent. The morbidity ranged from 0 9 to 2-2 per cent. In 1973, Petch, Sutton, and Jefferson re-ported a series of 400 angiograms with an overall mortality of 1P5 per cent; 2-4 per cent for the 248 done by Judkins ' (1967) method and a zero mor-tality for the 111 by Sones and Shirey's (1962) method. Adams, Fraser, and Abrams (1973), in a nationwide survey of the United States, found a 0-8 per cent mortality for Judkins ' technique and a 0 13 per cent mortality for Sones'. The purpose of this paper is to review our experience with particular reference to compli-cations. Coronary angiography at Harefield Hospital Originally, coronary angiograms were carried out by whichever investigator, consultant, or registra