Nonionic low‐osmolar contrast media have no impact on major adverse cardiac events in patients undergoing coronary stenting with appropriate antiplatelet therapy

Abstract

The aim of this study was to assess the impact of two nonionic low-osmolar monomers (iopamidol and iopromide) and one ionic low-osmolar dimeric contrast medium (ioxaglate) on 30-day major adverse cardiac events in patients undergoing coronary interventions involving the use of new-generation stents and appropriate antiplatelet agents. Thirteen hundred and eight patients treated with stent implantation were randomized to receive ioxaglate (438 patients), iopamidol (442 patients), or iopromide (428 patients). Most of them (55%) had an acute coronary syndrome. Glycoprotein IIb/IIIa inhibitors were used in 37% of cases. All of the patients were on aspirin and ticlopidine for 1 month after the procedure. There was no significant between-group difference in the incidence of the primary composite endpoint of major adverse cardiac events 30 days after stenting (ioxaglate 3.6%; iopamidol 2.3%; iopromide 4.2%; P = 0.27). Adverse drug reactions were more frequent in the ioxaglate group (4.6% vs. 1.1% vs. 0.5%; P = 0.001). Multivariate analysis showed that intracoronary thrombus (P = 0.002), diabetes mellitus (P = 0.01), and postprocedure minimum lumen diameter (P = 0.04) independently correlated with an adverse outcome after 1 month. In conclusion, no significant differences in 30-day major ischemic complications were observed in this unselected population of patients undergoing coronary stenting who received ioxaglate, iopamidol, or iopromide. These data seem to suggest that the use of nonionic low-osmolar contrast media does not adversely affect stent patency.

Renal disease and acute coronary syndrome

“…This remains difficult to achieve in routine practice as the mean (SD) contrast dose in a randomised study with 1308 elective patients (with CKD present in only 2% of them) was 279 (106) ml 22. This study did not find any significant differences between non-ionic and ionic contrast agents.…”

Impact of anticoagulation on ionic and nonionic contrast media effect on thrombogenesis and fibrinolysis: The PEPCIT study

“…There is some evidence to suggest that high‐osmolar CM are more likely to induce thrombosis than low‐osmolar or iso‐osmolar CM [32]. The differential effects between ICM and NICM on homeostasis have been the subject of controversies based on diverging study results, some studies suggesting that NICM are clearly more thrombogenic than ICM [4, 7–9, 11, 12, 17, 18, 21, 33] or at best neutral [5, 10, 13–16, 19], only one being in favor of NICM [6], most of them comparing the consequences of these effects on MACE following PCI (Table I). However, when combining data from studies which met criteria to be included in a metanalysis, Klein et al reported a substantial heterogeneity and an “overall” absolute difference in event rates of 4.6% in favor of ioxaglate which was nonsignificant given the wide confidence interval [20].…”

“…There is evidence showing that ionic low osmolar (ICM) (600–1000 mOsm/L) inhibits to a greater extent the coagulation cascade than nonionic iso‐osmolar (NICM) (280 mOsm/L) [1, 2] and does not activate resting platelets [3]. However, unlike experimental findings, the results of clinical trials comparing the effect of ICM and NICM to prevent percutaneous coronary intervention (PCI) complications remain divergent [4–19]. Several trials demonstrated better [4, 7–9, 11, 12, 17, 18] or neutral [5, 10, 13–16, 19] results with ICM and a single one was in favor of NICM [6] (Table I).…”

Effects of iodinated contrast media on blood and endothelium

“…Scheller et al [96] reported that patients undergoing stent placement had fewer acute and subacute stent occlusions when imaged with ioxaglate (versus multiple non-ionic agents). However, Danzi et al [95] recently reported that non-ionic monomers (iopamidol and iopromide) did not adversely affect stent patency when compared with ioxaglate. The considerable peri-procedural use of antiplatelet agents may explain their results.…”

“…Randomized trials comparing ioxaglate with non-ionic monomers during PTCA have produced conflicting results [89][90][91][92][93][94][95]. In the two studies with the largest number of patients, one showed no significant difference between ioxaglate and iomeprol in the incidence of sudden vessel occlusion [93] while the other showed a trend towards fewer thromboembolic complications with ioxaglate compared with ioversol [94].…”