Overconsumption of Contrast Media in Percutaneous Coronary Intervention: Focusing on Cost and Acute Kidney Injury

Abstract

Irrational use of medicines is a major problem worldwide. Since iodixanol (Visipaque®) was categorized in Category I based on the ABC-VED analysis in our hospital, we evaluated the amount of visipaque use and estimated the incremental cost based on the Maximum Contrast Dose (MCD) following irrational use of contrast media. This retrospective study was conducted on 100 admitted patients aged 18 to 80 years old undergoing elective Percutaneous Coronary Intervention (PCI) who received visipaque during February 2016 to January 2017. All of the patients’ information was collected from medical records and Hospital Information System (HIS). MCD was calculated by using the formula proposed by Cigarroa and colleagues: MCD (mL) =5× body weight (kg)/ Serum Creatinine (SCr) (mg/dl). The amount of contrast media administered ranged from 200 to 600 mL (mean, 348 mL ± 80). 57 % of patients received the visipaque more than MCD. Only 25 patients were evaluated SCr after PCI and in 11 (44%) of these patients SCr increased and 3 (12%) patients developed CI-AKI. Consumption of the contrast media was 2 to 3 times more than previous studies which could be the cause of acute kidney injury besides the extra cost. In our study about six liters more of contrast agent was used which is more than standard values with a cost of approximately $2,000 for 100 patients. Therefore, in order to reduce costs and complications, appropriate clinical protocol of contrast media, more supervision on medical residents and contrast infusion pumps, as well as a periodic evaluation study are highly recommended.