Mobile cardiac catheterization registry: Report of the first 1,001 patients

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Abstract
The purpose of this study was to evaulate prospectively the efficacy and safety of mobile cardiac catheterization. Mobile cardiac catheterization was introduced into clinical practice in 1989, but there has been no systematic study of its performance and safety. A registry was established in 1989 to monitor outcomes with mobile cardiac catheterization and is reported here. Patients were screened for eligibility for mobile cardiac catheterization using the joint AHA/ACC criteria for outpatient angiography. Eligible patients underwent mobile catheterization at eight hospitals within 120 miles of the base tertiary center. Helicopter evacuation services were available at each mobile site. The indications, findings, dispositions, and complications of mobile cardiac catheterization were recorded by means of a checklist, telephone follow‐up and chart review. A total of 1,001 consecutive patients were entered into the registry in the first 20 months of operation, including 436 females and 565 males aged 22 to 84 years. Angina (Canadian Classes II–IV) was the most frequent primary indication for catheterization (46.4%), followed by atypical chest pain (36.9%), or a positive exercise stress test (25.6%). Infrequent indications for catheterization included a history of myocardial infarction (5.6%), congestive heart failure (7.1%), arrhythmias (4.1%), and valvular heart disease (0.7%). Catheterization was accomplished in 99.9% of patients. Angiographically normal studies were observed in 22.8%, and mild (≤50%) coronary artery disease in 13.6% of patients. Significant one, two, and three vessel coronary artery disease was observed in 19.7, 16.0, and 18.0% respectively, and left mainstem disease was seen in 4.7% of patients. Only 27% required further referral to a tertiary site for additional diagnostic procedures, interventions, or surgery. Urgent referral for clinical instability was necessary in 0.9%, and major complications occurred in only 0.6% of patients. There were no deaths. When the joint AHA/ACC screening criteria for outpatient catheterization are used, a low risk population of patients can be appropriately identified for mobile cardiac catheterization. Mobile catheterization can be accomplished with a high procedural success rate and few complications. Most patients do not need further referral to a tertiary site for additional procedures. Mobile cardiac catheterization thus appears to be a safe and effective means of diagnostic angiography.