Abstract
Background The practical utility of minimum contrast procedures in a real world setting is unclear. In this trial, the reality of this strategy was investigated. Methods Patients with an estimated glomerular filtration rate (eGFR) of <=45 ml/min/1.73m2 were included in this study with dates ranging from Jan 17th 2012 to Oct 8th 2013. Various methods to minimize the amount of contrast media were applied. An achievement rate of contrast volume/eGFR<2.0 was calculated and the characteristics of the patients and catheter procedures were investigated. Results A total of 88 patients were enrolled. There were 34 patients who underwent a diagnostic coronary angiogram (CAG group) and 54 patients who underwent an interventional procedure (PCI group). The PCI group tended to use a larger amount of contrast media compared to the CAG group (39 ± 49 ml vs 25 ± 14 ml, p=0.06). A ratio of contrast volume to eGFR of less than 2.0 was achieved in 100% of the CAG group but in only 82% of the PCI group. The patients with complex procedures (complex PCI) such as use of a rotablator and treatment of chronic total occlusion used significantly more contrast media than patients with other procedures (simple PCI). (87 ± 69 ml vs 23 ± 27 ml, p=0.006) Surprisingly, when simple PCI group was compared to the CAG group, there was no difference in the contrast volume used. (23 ± 27 vs 25 ± 14 ml, p=0.708) Conclusions Simple PCI can be done as safely as in CAG patients with chronic kidney dysfunction. Complex PCI should be done with careful assessment of the balance between risk and benefit.
Highlights
Contrast induced nephropathy (CIN) is an important complication following exposure to iodinated contrast media
The percutaneous coronary intervention (PCI) group tended to use a larger amount of contrast media compared to the coronary angiogram (CAG) group (39 ± 49 ml vs 25 ± 14 ml, p=0.06)
The patients with complex procedures such as use of a rotablator and treatment of chronic total occlusion used significantly more contrast media than patients with other procedures. (87 ± 69 ml vs 23 ± 27 ml, p=0.006) Surprisingly, when simple PCI group was compared to the CAG group, there was no difference in the contrast volume used. (23 ± 27 vs 25 ± 14 ml, p=0.708)
Summary
Contrast induced nephropathy (CIN) is an important complication following exposure to iodinated contrast media. It is defined as an absolute creatinine level increase of 0.5 mg/dl and/or as a relative creatinine increase of 25% 48-72 hours after the usage of contrast media [1,2,3,4,5]. The established and widely accepted regimen to prevent the occurrence of CIN has only been hydration with intravenous infusion of isotonic saline (NaCl 0.9%). The practical utility of minimum contrast procedures in a real world setting is unclear. In this trial, the reality of this strategy was investigated
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