Early clinical experiences with a novel contrast volume reduction system during invasive coronary angiography

Bruno, Raphael Romano; Nia, Amir M.; Wolff, Georg; Erkens, Ralf; Kelm, Malte; Westenfeld, Ralf; Jung, Christian

doi:10.1016/j.ijcha.2019.100377

Cited by 4 publications

(6 citation statements)

References 19 publications

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“…Contrast media volume is a key factor for the development of CIN, especially in high-risk patients [ 34 ] and may be managed accordingly: the use of biplane angiography systems helps to reduce contrast media exposure [ 35 ]. There are technical devices which are efficient in reducing contrast media over-injection [ 36 ]. The use of intravascular ultrasound (IVUS) and physiological guidance [ 37 ] may help in decreasing contrast media volume exposure for high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

et al. 2021

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Background Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study. Methods and results Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72–0.78; vs. Mehran c-index 0.69, 95% CI 0.66–0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12–0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79–0.91; vs. Mehran c-index 0.75, 95% CI 0.66–0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk. Conclusion In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the GRACE model while showing less accurate calibration. Results for the outcome ‘need for dialysis’ were equivocal. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

et al. 2021

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“…Of 24 studies that underwent full-text screening, 7 were deemed ineligible based on exclusion criteria. The remaining 17 studies were included in the qualitative review and quantitative meta-analysis ( 27 , 28 ). Results of the study selection process are depicted in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies involved the use of manual CM injection systems ( Table 1 ). Two studies reported use of the DyeVert System with an automated CM injection system, of which Bruno et al was a sub-set of Amoroso et al data and reported the author’s single-center experience ( 28 , 43 ). Nine studies included a control group composed of cases using routine CM injection systems and imaging practices without the DyeVert System (control group).…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies reported on adverse events and no DyeVert System-related adverse events were reported ( 27 , 28 , 30 , 35 – 39 , 42 ). Corcione et al described a case of contrast-induced nephropathy in a patient who underwent a combined carotid angiography and angioplasty and experienced elevated serum creatinine levels that returned to baseline 3 days after the procedure; the authors noted the event was not device-related ( 38 ).…”

Section: Resultsmentioning

confidence: 99%

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DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis

et al. 2022

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BackgroundContrast-associated acute kidney injury (CA-AKI) is an important adverse effect associated with injecting iodinated intra-arterial contrast media (CM) during coronary angiography. The DyeVert™ Contrast Reduction System is a medical device intended to reduce the intra-arterial CM volume (CMV) administered. The aim of this study was to assess DyeVert System clinical effectiveness and safety by implementing a systematic review and meta-analysis of existing evidence.MethodsSystematic electronic literature searches were conducted in MEDLINE, Embase, the Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the International Clinical Trials Registry Platform database. Relevant data were extracted from included studies and meta-analyses were performed to synthesize evidence across studies.ResultsThe review included 17 eligible studies involving 1,731 DyeVert System cases and 1,387 control cases (without the use of DyeVert). Meta-analyses demonstrated use of the DyeVert System reduced CMV delivered to the patient by 39.27% (95% CI, 36.10–42.48%, P < 0.001), reduced CMV/baseline renal function ratios (Hedges’s g, −0.56; 95% CI, −0.70 to −0.42, P < 0.001) and percentage of cases exceeding the maximum CMV threshold (risk difference −0.31, 95% CI, −0.48 to −0.13, P < 0.001) while maintaining adequate image quality in 98% of cases. DyeVert System cases demonstrated lower CA-AKI incidence vs. controls (absolute risk reduction 5.00% (95% CI, 0.40–9.80%; P = 0.03), relative risk 0.60 (95% CI, 0.40–0.90; P = 0.01) with a pooled estimate of the number needed to treat with the DyeVert System to avoid 1 CA-AKI event of 20.ConclusionDyeVert System use significantly reduces CMV delivered to the patient, CMV/baseline renal function ratios, and CA-AKI incidence while maintaining image quality. Accordingly, the device may serve as an adjunctive, procedure-based strategy to prevent CA-AKI. Future multi-center studies are needed to further assess effects of minimizing CMV on endpoints such as CA-AKI prevention, incidence of adverse cardiac and renal events, and health care costs.

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“…However, apart from ensuring sufficient hydration and limiting the total amount of contrast media, there are no evidenced‐based measures against contrast‐induced nephropathy. Recently, the combination of a fluid pathway resistance modulator and an automatic power injection system was released, promising a reduction of the needed contrast media without a loss in image quality …”

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confidence: 99%

Spotlight on comorbidities in STEMI patients

Bruno

Kelm

Jung

2019

Endocrino Diabet & Metabol

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Mortality for myocardial infarction is at its lowest historical level for 20 years, but comorbidities such as anemia, renal failure and hyperglycemia seem the next frontier to investigate their impact as risk modifiers mortality in acute myocardial infarction. Stress hyperglycemia is a very frequent problem in STEMI, but continuous insulin infusion therapy (CIIT) resulted in >threefold and >twofold increased risks in‐hospital and 1‐year mortality, respectively.

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Early clinical experiences with a novel contrast volume reduction system during invasive coronary angiography

Cited by 4 publications

References 19 publications

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis

Spotlight on comorbidities in STEMI patients

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