Acute and subacute stent occlusion; risk-reduction by ionic contrast media

Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (< or =72 h) and subacute (< or =30 days) stent thrombosis has not been investigated.

Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention.

Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1.3% in group I vs 0.3% in group II, P=0.001; subacute stent occlusion: 2.4% in group I vs 0.7% in group II, P=0.001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22.9% vs 16.3%, P=0.001).

Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated.