Letter. Outpatient versus inpatient catheterization. Block P. NEJM 1989; 320:938-939
the Editor: We
reviewed our data concerning patients who had myocardial infarction. The onset
of prolonged chest pain occurred at the time of cardiac catheterization in all
instances. Patients were then listed as having a presumed myocardial infarction.
No patients had prolonged chest pain or myocardial infarction while being
after their return to the surgical day care unit or after ambulation was begun
in the outpatient group. Thus, we conclude that outpatient status had no bearing
on the development of myocardial infarction.
reviewing the specific patients who had myocardial infarction, it turned out
that the patients who had prolonged chest pain in the cardiac catheterization
laboratory were first listed as having presumed myocardial infarction and were
then later also listed as having myocardial infarction; hence, each patient
was tallied twice.
Therefore, our total incidence of myocardial infarction was
0.5 percent (2 of 381 patients).
patient who had a myocardial infarction had diffuse, severe three-vessel disease
with stable angina pectoris. Neither embolism nor acute thrombosis occurred at
cardiac catheterization to account for the myocardial infarction. The second
patient was found to have less than total occlusion of the left anterior
descending coronary artery. Percutaneous transluminal coronary angioplasty was
performed. Prolonged chest pain developed, and myocardial infarction was
confirmed by enzyme levels later in the hospitalization.
Thus, only one patient had a myocardial infarction. Our conclusion
remains that outpatient catheterization seems to be a safe alternative for selected patients in stable condition.
C. Block, M.D. Boston, MA 02114
Harvard Medical School