A randomized trial of low osmolar ionic versus nonionic contrast media in patients with myocardial infarction or unstable angina undergoing percutaneous transluminal coronary angioplasty

Abstract

These findings demonstrate that in patients with unstable ischemic syndromes undergoing coronary angioplasty, the use of ionic low osmolar contrast media reduces the risk of ischemic complications acutely and at 1 month after the procedure. Therefore, low osmolar ionic contrast media should be strongly considered when performing interventions in patients with unstable angina or myocardial infarction.

Differential effects of three radiographic contrast media on platelet aggregation and degranulation: implications for clinical practice?

“…Our data suggest the risk of thromboembolic complications could be minimized by avoiding the use of non-ionic low osmolar contrast media (Grines et al, 1996). Another approach would be to inhibit the effects of such agents on platelets.…”

“…The potentiatory effects of non-ionic low-osmolar contrast media on platelet function demonstrated in these investigations suggest a mechanism through which such agents could contribute to thromboembolic complications during diagnostic and therapeutic arteriographic interventions (Gasperetti et al, 1991;Aguirre et al, 1995;Grines et al, 1996). Facilitation of platelet responses to ADP (and possibly other platelet aggregating agents) could increase platelet deposition on damaged endothelium or foreign surfaces such as intravascular catheters, guidewires or stents, and thus increase thromboembolic risk.…”

“…Concerns have been expressed that some radiographic contrast media may contribute to thromboembolic complications during arteriography (Editorial, 1992;Moliterno & Topol, 1996). The newer non-ionic low-osmolar media are of particular concern in this regard (Hwang et al, 1989;Kopko et al, 1990;Esplugas et al, 1991;Gasperetti et al, 1991;Casalini, 1992;Piessens et al, 1993;Aguejouf et al, 1995;Aguirre et al, 1995;Grines et al, 1996), and an increased thrombogenic tendency and higher rates of ischaemic complications after coronary angioplasty have been observed with these media (Gasperetti et al, 1991;Aguirre et al, 1995;Grines et al, 1996).…”

Rails, reopro™, and the real world

“…These levels were rarely allowed in the EPILOG study. In addition, nonionic contrast use was frequent in the EPILOG group, and this is known to cause adverse outcomes in PTCA [7,8]. Whether CPK elevations are of clinical relevance remains speculative.…”

Intracoronary Epinephrine for Contrast-Medium-Induced Microvascular Obstruction in a Chronically Hemodialyzed Patient

“…Despite the higher viscosity that could contribute to stasis in the microcirculation, the non-ionic, iso-osmolar CM iodixanol seems to present a better safety profi le compared to other CM [6] . Clinical studies have evaluated the vasomotor effects of different CM agents: the usual reaction to CM injection in normal individuals is a transient vasodilatation [7][8][9] . An altered vasomotor response to non-ionic CMs (iodixanol and iopramide) was demonstrated in coronary epicardial segments of patients with an overt coronary artery disease [10] .…”