How safe is the coronary angiogram?

Adams, Douglass F.

doi:10.1007/bf02552305

Cited by 12 publications

(3 citation statements)

References 29 publications

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“…During coronary arteriography a number of haemodynamic and electrophysiological changes can be observed which are often thought to be due to the contrast media used. After the introduction of low osmolality contrast media, radiographic examinations of the heart have become safer (Adams 1982). These new agents include both ionic and non-ionic compounds.…”

mentioning

confidence: 99%

Electromechanical Effects of Two Low Osmolality Contrast Media, Ioxaglate and Iohexol, on Isolated Rat Atria

Tande¹,

Klew

Refsum³

1990

Pharmacology & Toxicology

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This study aimed at investigating the direct effects of two low osmolality radiographic contrast media, iohexol (non-ionic) and ioxaglate (ionic), on transmembrane action potentials, contractile force and refractoriness of isolated rat atrial preparations. Superfused with 10% solution, ioxaglate induced a biphasic mechanical response, initially decreasing and thereafter increasing contractile force. The same concentration of iohexol only increased contractile force. The two contrast media increased the resting membrane potential, action potential amplitude and rate of depolarization to the same extent. Iohexol prolonged repolarization. Both contrast media decreased the effective refractory period. The direct effects of contrast media on myocardial contractility in this study can explain the different haemodynamic effects of iohexol and ioxaglate in vivo. The observed effects on the action potentials in vitro can explain commonly observed ECG changes during coronary arteriography. The changes in depolarization, repolarization and refractoriness are probably related to the arrhythmogenic properties of these contrast media.

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mentioning

confidence: 99%

Electromechanical Effects of Two Low Osmolality Contrast Media, Ioxaglate and Iohexol, on Isolated Rat Atria

Tande¹,

Klew

Refsum³

1990

Pharmacology & Toxicology

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“…If we consider the morbidity of angiography in addition to its mortality, there is little effect on the conclusions. Major complications (myocardial infarction and cerebral embolism) occur at a rate of approximately 0.2 percent (0.14%-0.27%) [24]. If QALE is halved following these major complications, there is very little effect on the choice of strategies in Table 5 (e.g., the strategies change in only four cases when the dollar-year trade-off is above $15,000) and only a minor effect on the two general conclusions.…”

Section: Sensitivity Analysismentioning

confidence: 99%

The Decision Concerning Coronary Angiography in Patients with Chest Pain

Doubilet¹,

McNeil²,

Weinstein³

1985

Med Decis Making

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We examined the decision whether to perform coronary angiography (followed by bypass surgery if appropriate findings are present) in middle-aged men who have chest pain and have undergone exercise tolerance testing (ETT). We developed a model of this decision that combines data from a variety of sources and selects the optimal strategy based on health outcome and, if desired, monetary cost. The analysis supports the following conclusions: for patients with nonspecific chest pain or atypical angina, the ETT provides useful information concerning the decision; furthermore, the number of millimeters of ST-segment depression above which angiography should be performed depends on coronary risk factors and pain severity. A normal ETT is insufficient evidence to exclude coronary angiography for patients with typical angina, provided that one is willing to expand resources for health benefits at levels comparable to those for other accepted medical practices. If monetary considerations are excluded, the preceding statement concerning ETT and angiography also holds for patients with atypical angina and for those with nonspecific pain and advanced risk factors. These last two conclusions suggest that ETT is not useful in guiding management decisions concerning coronary angiography in patients at high enough risk of coronary artery disease on the basis of symptoms and risk profile.

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“…The latter arrangement denies the existence of interventional radiology as a discipline and, more importantly, diminishes standards of practice. It has been shown repeatedly in a variety of specialties that there is a relation between the volume of procedures carried out and the standards achieved [2][3][4][5]. A radiologist who spends most of his time practising intervention is more likely to attract a sufficient volume of procedures for the maintenance of high standards.…”

mentioning

confidence: 99%

Interventional radiology: there is no need for quotation marks

Adam

1997

Eur Radiol

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How safe is the coronary angiogram?

Cited by 12 publications

References 29 publications

Electromechanical Effects of Two Low Osmolality Contrast Media, Ioxaglate and Iohexol, on Isolated Rat Atria

Electromechanical Effects of Two Low Osmolality Contrast Media, Ioxaglate and Iohexol, on Isolated Rat Atria

The Decision Concerning Coronary Angiography in Patients with Chest Pain

Interventional radiology: there is no need for quotation marks

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