Impact of a contrast media volume control device on acute kidney injury rate in patients with acute coronary syndrome

Abstract

BACKGROUND The DyeVert™ system (Osprey Medical Inc., Minnesota, MN) may reduce contrast media (CM) volume during coronary procedures while maintaining fluoroscopic image quality. Here, we assessed whether the use of the DyeVert system reduces acute kidney injury (AKI) rate in patients with acute coronary syndrome (ACS) undergoing invasive coronary procedures. METHODS ACS patients scheduled for coronary procedure from January 2017 to December 2019 were included. Two groups were identified: (a) Control group (n = 339), including patients in which a conventional manual injection syringe was used; and (b) DyeVert group (n = 112), in which CM injection was handled by the DyeVert™ system. A propensity score matching was performed to reduce the effect of treatment selection bias and potential confounders. In all cases, a low‐osmolar, nonionic CM was administered. The primary objective was the rate of AKI, defined as a serum creatinine increase ≥0.3 mg/dl within 72 hr after CM exposure. RESULTS CM volume was higher in the Control group than in the DyeVert group (130 [120–188] ml vs. 99 [69–136] ml; p <.001). In the DyeVert group the mean percent CM volume saved was 38 ± 13%. AKI occurred in 7/90 patients (8%) in the DyeVert group and in 17/90 (19%) patients in the Control group (odds ratio = 0.37; 95% confidence interval 0.14–0.95; p =.047). CONCLUSIONS This preliminary result suggests that CM volume reduction obtained by the DyeVert™ system is an effective strategy to prevent AKI in ACS patients undergoing invasive procedure.

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

“…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 ).…”

Contemporary Modalities in the Prevention of Contrast-Induced Acute Kidney Injury

“…This CM volume reduction translated in a lower incidence of CI-AKI in a study of 451 patients undergoing coronary procedures for acute coronary syndromes (DyeVert™: 8% vs. Control: 19%) [76].…”

Acute coronary syndrome and renal impairment: a systematic review

“…In the AVERT trial, AVERT™ system, in spite of having demonstrated a decrease in the volume of CM compared to traditional methods, failed to accomplish a reduction in the incidence of contrast induced nephropaty (CIN), suggesting that the obtained reduction in the volume of CM that had been obtained was not sufficient to reduce the incidence of AKI [24]. The DyeVert™ system has been recently assesed in a retrospective analysis [25] of 112 patients with ACS undergoing primary PCI: use DyeVert resulted in lower contrast media used (130 [120-188] mL vs. 99 mL; p < 0.001) and lower incidence of contrast induced AKI (odds ratio [OR] = 0.37; 95% confidence interval [CI] 0.14-0.95; p = 0.047) compared to propensity score matched controls. An ongoing trial (ClinicalTrials.gov Identifier: NCT04714736) is assessing DyeVert™ system in ACS setting.…”