Abstract 15109: Percutaneous Coronary Intervention During the Global Shortage of Iodinated Contrast

Abstract

Background: A recent coronavirus-related factory shutdown led to a global shortage of iodinated contrast media. Its impact on percutaneous coronary interventions (PCI), which require contrast, has not been investigated. Research Question: The purpose of the study was twofold: (1) to evaluate the impact of the contrast shortage on PCI procedure volumes, patient and procedure characteristics and (2) to evaluate whether those changes impacted patient outcomes, especially acute kidney injury (AKI). Methods: Using CathPCI registry data from 19 Viriginia hospitals, we evaluated two time periods: pre-shortage (May 2021 - April 2022) and during the contrast shortage (May 2022 - October 2022). We compared procedure volumes, patient and procedure characteristics, and short-term outcomes. Of primary interest was whether a reduction in contrast would reduce the incidence of AKI. Results: There were 8,980 patients in the pre-shortage period and 4,046 during the shortage. Procedure volumes per hospital and patient characteristics remained similar. Multivessel procedures declined during the shortage (45.3% vs. 42.8%, p=0.007). There was a sharp decline in contrast per procedure during the shortage (149.9 ± 68.1 mL per case to 137.5 ± 62.4 mL (p<0.0001) that began at the start of the shortage and then continued throughout. There were no differences in patient outcomes, including AKI (7.9% versus 7.4%, p=0.40), between study periods. When limited to patients at increased risk of AKI, there remained no difference in AKI between the study periods, despite a similar decrease in contrast volume in that cohort. Multivariable analysis showed strong correlation between baseline risk of AKI and subsequent AKI (p<0.0001), but no impact of procedure characteristics or the timing of the PCI. Conclusions: The global shortage of iodinated contrast led to a significant decline in contrast use during PCI, with no impact on patient outcomes.