Randomized Trial of Contrast Media Utilization in High-Risk PTCA

Davidson, Charles J.; Laskey, Warren K.; Hermiller, James; Harrison, J. Kevin; Matthai, William H.; Vlietstra, Ronald E.; Brinker, Jeffrey A.; Kereiakes, Dean J.; Muhlestein, Joseph B.; Lansky, Alexandra J.; Popma, Jeffrey J.; Buchbinder, Maurice; Hirshfeld, John W.

doi:10.1161/01.cir.101.18.2172

Cited by 105 publications

(85 citation statements)

References 21 publications

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“…The other two contrast media, ioxilan and iomeprol, caused less P-selectin expression, suggesting that common mechanism(s) may be contributing to the differences in both platelet aggregation and degranulation. These results are consistent with the recent results of the COURT trial (contrast media utilization in high risk PTCA, 18) which suggested that isomolar nonionic dimer iodixanol reduced in-hospital major clinical events. Taken together, these data indicate that nonionic molecules directly affect the platelets, implying that any contrast In previous studies the blood samples were collected through a syringe needle, which may have affected the measurement of platelet aggregation.…”

Section: Discussionsupporting

confidence: 92%

Effects of Nonionic Contrast Media on Platelet Aggregation. Assessment by Particle Counting with Laser-Light Scattering.

et al. 2001

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SUMMARYIntravascular radiographic contrast media used in angiography, particularly nonionic contrast media, may cause activation of platelets. This study was designed to determine which properties of nonionic contrast media were potentially responsible for this action. Platelet aggregation after adenosine diphosphate stimulation was studied in the platelet rich plasma obtained from 37 patients who underwent left ventriculography using the highly sensitive method of particle counting with laser-light scattering. Platelet activation by contrast media was studied in the platelet rich plasma from healthy volunteers using flow cytometric analysis to detect platelet degranulation as P-selectin expression. There was a significant decrease in platelet aggregation in patients injected with ioxilan or iomeprol compared with patients injected with iohexol. There was a significant increase in Pselectin expression with the three groups of contrast media compared to control. The platelet activation with ioxilan or iomeprol was significantly less compared to the activation with iohexol. The comparison showed that previous generalization regarding platelet activation by nonionic contrast media might not be valid. It is presumed that the higher osmolality of iohexol may contribute to the increase in platelet aggregation and activation. (Jpn Heart J 2001; 42: 115-124) Key words: Angiography, Blood, Coagulation, Complications, Flow cytometry, Osmolality, P-selectin, Thrombus COMPARED with high osmolar ionic contrast media nonionic low osmolar contrast media have been shown to have low toxicity and superior clinical tolerance, and to decrease the incidence of major complications associated with diagnostic cardiac catheterization. At present low osmolar contrast medium is considered to be safer than high-osmotic contrast medium.1) But an increase in thrombotic complications has been implicated with nonionic low osmolar contrast medium. When blood is mixed with nonionic medium in a syringe or cathe-

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Section: Discussionsupporting

confidence: 92%

Effects of Nonionic Contrast Media on Platelet Aggregation. Assessment by Particle Counting with Laser-Light Scattering.

et al. 2001

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“…Because patients with CKD reveal a higher frequency of diffuse disease and an increased rate of multivessel disease, applied contrast volumes are generally higher compared with regular patients. 9 Although the incidence of contrast media-induced nephropathy (CIN) in patients with preserved renal function is very low, 10 the risk for patients with risk factors such as chronic renal failure and diabetes is considerably increased and ranges between approximately 12% and 50%. 11 Importantly, it is elevated even in patients with moderate renal dysfunction.…”

Section: Clinical Perspective On P 437mentioning

confidence: 99%

“…The average contrast volume delivered for diagnostic angiography immediately following coronary intervention was 367 mL, which is in good accordance with the COURT trial that studied the impact of different contrast media on the incidence of major adverse cardiac events after PCI. 9 Other trials that included a significant portion of patients solely undergoing coronary angiography without PCI reported the use of lower amounts of contrast media, such as in NEPHRIC 11 (Ϸ163 mL), RECOVER 22 (Ϸ200 mL), and CARE 23 (Ϸ135 mL).…”

Section: Wessely Et Al Contrast Media-induced Nephrotoxicity and Pcimentioning

confidence: 99%

“…In this context, it should be acknowledged that the COURT trial reported a lower major adverse coronary event rate at 30 days in patients who received iodixanol undergoing PCI. 9 Formerly, the NEPHRIC study that included exclusively diabetic patients with impaired renal function found a significantly lower incidence of nephrotoxicity associated with iodixanol use compared with a low-osmolar contrast medium after coronary angiography. Therefore, we conducted a prespecified subgroup analysis for diabetic patients.…”

Section: Wessely Et Al Contrast Media-induced Nephrotoxicity and Pcimentioning

confidence: 99%

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Choice of Contrast Medium in Patients With Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Wessely

Koppara

Bradaric

et al. 2009

Circ: Cardiovascular Interventions

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MD; for the Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty (CONTRAST) Trial investigatorsBackground-No clinical trial has yet focused on contrast-mediated nephrotoxicity in patients with chronic renal failure exclusively undergoing percutaneous coronary intervention (PCI). Therefore, the aim of this study was to compare the effect of contemporary contrast media on nephrotoxicity in this high-risk patient population. Methods and Results-This prospective, randomized, double-blind, comparative clinical trial randomly selected 939 patients with chronic renal failure undergoing coronary angiography with potential PCI to receive either the iso-osmolar contrast medium iodixanol or the low-osmolar contrast medium iomeprol. Of those 939 patients, 615 received diagnostic angiography only and were not included in the primary study analysis, but were followed up in a registry. Three hundred twenty-four patients underwent PCI, of which one-half received iodixanol or iomeprol, respectively, and were included in the primary study analysis. The primary end point was the peak increase in S-creatinine during hospitalization for PCI. Maximum increase in S-creatinine after PCI was lower than expected and thus impaired the power of the study. It was not significantly different between the 2 contrast groups (0.19Ϯ0.40 mg/dL for iodixanol and 0.21Ϯ0.34 mg/dL for iomeprol; Pϭ0.53). Albeit contrast media-induced nephropathy rates were lower with iodixanol (22.2% compared with 27.8% for iomeprol), this difference was not statistically different (Pϭ0.25). Subgroup analysis suggested a favorable outcome regarding nephrotoxicity in patients who received higher contrast volumes (Ͼ340 mL) in the iodixanol group (P interaction ϭ0.016). Conclusions-Routine use of iso-osmolar contrast medium is not associated with a significant reduction of nephrotoxicity compared with low-osmolar contrast medium in patients with chronic renal failure undergoing PCI. However, a positive effect was seen in the iso-osmolar contrast group for patients receiving high amounts of contrast medium, which awaits confirmation of a specifically designed randomized clinical trial. Clinical Trial Registration-clinicaltrials.gov Identifier: NCT00390585 (Circ Cardiovasc Intervent. 2009;2:430-437.)

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“…19 These changes occur because of cytotoxity and increased viscosity of the contrast media. In the present study, almost all patients had Iodixanol (visipaque), a nonionic, dimeric, and iso-osmolar contrast medium, which is shown to have a low nephrotoxic effect in different subsets of patients with or without impaired renal function, 20,21 but the matter of which type of contrast media that is most kidney-friendly is still under debate. 22 The relationship between impaired renal function after contrast media and prognosis has been well documented with a poorer prognosis for an impaired kidney function, as well in patients with precontrast-impaired kidney function.…”

Section: Discussionmentioning

confidence: 65%

Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment–Myocardial Infarction

Thayssen

Lassen

Jensen

et al. 2014

Circ: Cardiovascular Interventions

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Background-Contrast-induced nephropathy (CIN) is a serious condition in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. We compared the risk of acute CIN and the influence of preventive strategies in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-A total of 720 patients were randomized in the Prevention of Contrast-induced Nephropathy inPatients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (CINSTEMI) trial. Patients were randomly assigned in a 1:1:1:1 ratio to receive hydration with sodium chloride together with 1 of 4 prophylactic regimes (1) N-acetylcysteine (NAC), (2) sodium bicarbonate (NaHCO 3 ) infusion, (3) NAC in combination with NaHCO 3 , or (4) hydration with sodium chloride infusion alone. Patients in cardiogenic shock were excluded. Acute CIN was defined as an increase in serum creatinine concentration >25% from the baseline value within a 3-day period. Overall, CIN occurred in 141 (21.9%) patients. The prevention treatment with NAC, NaHCO 3 , or the combined NAC and NaHCO 3 did not reduce the rate of CIN significantly compared with hydration with intravenous sodium chloride infusion alone (20.1% versus 20.1% versus 20.8% versus 26.5%; P=NS). However, an increase in serum creatinine >25% from the baseline value to 30 day was significantly lower in patients treated with combined NAC and

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Randomized Trial of Contrast Media Utilization in High-Risk PTCA

Cited by 105 publications

References 21 publications

Effects of Nonionic Contrast Media on Platelet Aggregation. Assessment by Particle Counting with Laser-Light Scattering.

Effects of Nonionic Contrast Media on Platelet Aggregation. Assessment by Particle Counting with Laser-Light Scattering.

Choice of Contrast Medium in Patients With Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment–Myocardial Infarction

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