Risk Factors for Anaphylactoid Reaction to Low Osmolar Contrast During Cardiac Catheterization

Abstract

RATIONALE: Beta blockers(BB) have been associated with increased risk for severe anaphylactoid reaction(AR) from contrast media(CM); however, this was shown with intravenous CM(Arch Intern Med 1993;153:2033), prior to widespread use of low osmolar contrast media(LOCM), ACE inhibitors(ACE-I) and cardioselective BB. We assessed risk for AR with cardiac catheterization(CC) associated with BB or ACE-I exposure. METHODS: Patients who experienced adverse reactions during CC from January 2004-December 2013 were identified; 1-2 matched controls were assigned for each case. We analyzed AR rates in association with demographic variables, medication exposures (BB, ACE-I, Angiotensin receptor blockers, aspirin) and co-morbidities: cardiovascular disorders(CVD), asthma, atopy. RESULTS: We analyzed 71,782 CCs. Of these, severe 70 reactors were identified-46 (0.06%) fulfilled AR criteria. There were 35 mild-moderate and 11 severe AR (0.015%). There were no significant differences in age (61.3% vs 61.5%), gender (63% vs 64% male), CVD rate (78% vs 93%), exposure to BB (46% vs 51%, cardioselective: 81% vs 80%) and ACE-I (37.0% vs 37.2%) in cases vs. controls. Via multivariate logistic regression, BB exposure was not associated with greater AR frequency(p50.35) or severity (p50.40). Neither cardioselective BBs (p5 0.2) nor noncardioselective BB (p50.5) influenced AR severity. ACE-I had no effect on AR frequency (p50.35) or severity (p50.14). Lower AR frequency was associated with CVD (p50.01). CONCLUSIONS: In this case control-study, severe AR were rarely observed. Exposure to BB or ACE-I did not significantly influence AR frequency or severity; however, most BB were cardioselective. Our findings imply cardioselective BB or ACE-I suspension is not warranted in association with CC.