The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study

We sought to determine the incidence of cholesterol embolization syndrome (CES) as a complication of cardiac catheterization and to identify risk factors associated with this disease. Cholesterol embolization syndrome is a systemic disease caused by distal showering of cholesterol crystals after ang...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2003-07, Vol.42 (2), p.211-216
Main Authors: Fukumoto, Yoshihiro, Tsutsui, Hiroyuki, Tsuchihashi, Miyuki, Masumoto, Akihiro, Takeshita, Akira
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Acute Kidney Injury - etiology
Adult
Aged
Aged, 80 and over
Analysis of Variance
Arteriosclerosis - complications
Blood pressure
Blue Toe Syndrome - etiology
C-Reactive Protein - metabolism
Cardiac Catheterization - adverse effects
Cardiology
Cardiovascular disease
Cholesterol
Confidence intervals
Coronary vessels
Creatinine - blood
Diabetes
Embolism, Cholesterol - blood
Embolism, Cholesterol - diagnosis
Embolism, Cholesterol - epidemiology
Embolism, Cholesterol - etiology
Eosinophils
Heart attacks
Hemodialysis
Hospital Mortality
Humans
Hypertension
Hypertension - complications
Incidence
Intubation
Leukocyte Count
Middle Aged
Mortality
Multivariate analysis
Predictive Value of Tests
Prospective Studies
Regression Analysis
Risk Factors
Skin Diseases, Vascular - etiology
Smoking - adverse effects
Studies
Syndrome
Variables
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Summary:We sought to determine the incidence of cholesterol embolization syndrome (CES) as a complication of cardiac catheterization and to identify risk factors associated with this disease. Cholesterol embolization syndrome is a systemic disease caused by distal showering of cholesterol crystals after angiography, major vessel surgery, or thrombolysis. We prospectively evaluated a total of 1,786 consecutive patients 40 years of age and older, who underwent left-heart catheterization at 11 participating hospitals. The diagnosis of CES was made when patients had peripheral cutaneous involvement (livedo reticularis, blue toe syndrome, and digital gangrene) or renal dysfunction. Twenty-five patients (1.4%) were diagnosed as having CES. Twelve patients (48%) had cutaneous signs, and 16 patients (64%) had renal insufficiency. Eosinophil counts were significantly higher in CES patients than in non-CES patients before and after cardiac catheterization. The in-hospital mortality rate was 16.0% (4 patients), which was significantly higher than that without CES (0.5%, p < 0.01). All four patients with CES who died after cardiac catheterization had progressive renal dysfunction. The incidence of CES increased in patients with atherosclerotic disease, hypertension, a history of smoking, and the elevation of baseline plasma C-reactive protein (CRP) by univariate analysis. The femoral approach did not increase the incidence, suggesting a possibility that the ascending aorta may be a potential embolic source. As an independent predictor of CES, multivariate regression analysis identified only the elevation of pre-procedural CRP levels (odds ratio 4.6, p = 0.01). Cholesterol embolization syndrome is a relatively rare but serious complication after cardiac catheterization. Elevated plasma levels of pre-procedural CRP are associated with subsequent CES in patients who undergo vascular procedures.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(03)00579-5