Circulation, Vol 85, 462-468, Copyright © 1992 by American Heart Association
PD Stein, C Athanasoulis, A Alavi, RH Greenspan, CA Hales, HA Saltzman, CE Vreim, ML Terrin and JG Weg
BACKGROUND. The Prospective Investigation of Pulmonary Embolism Diagnosis
(PIOPED) addressed the value of ventilation/perfusion scans in acute
pulmonary embolism (PE). The present study evaluates the risks and
diagnostic validity of pulmonary angiography in 1,111 patients who
underwent angiography in PIOPED. METHODS AND RESULTS. Complications were
death in five (0.5%), major nonfatal complications in nine (1%), and less
significant or minor in 60 (5%). More fatal or major nonfatal complications
occurred in patients from the medical intensive care unit than elsewhere:
five of 122 (4%) versus nine of 989 (1%) (p less than 0.02). Pulmonary
artery pressure, volume of contrast material, and presence of PE did not
significantly affect the frequency of complications. Renal dysfunction,
either major (requiring dialysis) or less severe, occurred in 13 of 1,111
(1%). Patients who developed renal dysfunction after angiography were older
than those who did not have renal dysfunction: 74 +/- 13 years versus 57
+/- 17 years (p less than 0.001). Angiograms were nondiagnostic in 35 of
1,111 (3%), and studies were incomplete in 12 of 1,111 (1%), usually
because of a complication. Surveillance after negative angiograms showed PE
in four of 675 (0.6%). Angiograms, interpreted on the basis of consensus
readings, resulted in an unchallenged diagnosis in 96%. CONCLUSIONS. The
risks of pulmonary angiography were sufficiently low to justify it as a
diagnostic tool in the appropriate clinical setting. Clinical judgment is
probably the most important consideration in the assessment of risk.
ARTICLES
Complications and validity of pulmonary angiography in acute pulmonary embolism
Henry Ford Heart and Vascular Institute, Detroit, Mich. 48202.
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