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Determinants of amount of contrast utilized in patients undergoing percutaneous coronary procedures
Jyotiranjan Pradhan1, Ashutosh Niraj, Luis Afonso
1Harper University Hospital, Wayne State University, Detroit Medical center, Detroit, Michigan, USA.
Insights
Predictors of contrast volume in coronary procedures were identified. History of coronary artery bypass grafting and type of procedure significantly influenced contrast amount, aiding in planning complex interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Contrast-induced nephropathy is a significant cause of hospital-acquired acute renal insufficiency.
- Contrast volume during percutaneous coronary procedures is a key risk factor for contrast-induced nephropathy.
Purpose of the Study:
- To identify predictors of contrast volume used during coronary angiography and percutaneous coronary intervention.
- To inform strategies for moderating contrast utilization in cardiac procedures.
Main Methods:
- Retrospective analysis of demographic and procedural data from 962 patients undergoing percutaneous coronary procedures between January 2002 and October 2005.
- General Linear Model analysis to identify independent predictors of contrast amount.
Main Results:
- History of coronary artery bypass grafting, percutaneous coronary intervention (vs. angiography), number of interventions, and additional procedures (rotablation, intravascular ultrasound, Angiojet) were independent predictors of increased contrast volume.
- No significant effect on contrast amount was observed based on percutaneous coronary intervention location or intervention on chronic total occlusions.
Conclusions:
- Findings can guide interventional cardiologists in moderating contrast volume during procedures.
- Data assists in the elective planning of complex therapeutic cardiac interventions to minimize contrast-induced nephropathy risk.
Objective:
To determine predictors of contrast amount during coronary angiography and percutaneous coronary intervention.
Background:
Contrast-induced nephropathy is a leading cause of hospital-acquired acute renal insufficiency. During percutaneous coronary procedures, contrast amount is a major risk factor incriminated in development of contrast-induced nephropathy.
Methods:
Demographic and procedural details were obtained for consecutive patients undergoing percutaneous coronary procedures between January 2002 and October 2005 (N=962, mean+/-standard error of contrast amount: 216.6+/-3.0 ml) at a tertiary care hospital.
Results:
A significant difference (P value <0.05) in unadjusted mean contrast volume was observed between subgroups of percutaneous coronary intervention vs. coronary angiography, patients with a history of coronary artery bypass grafting, patients undergoing additional procedures and multivessel and multisite percutaneous coronary interventions. On General Linear Model analysis, independent predictors (beta coefficient, 95% confidence interval, P value) of increased contrast amount during percutaneous coronary procedures were history of coronary artery bypass grafting (44.4, 30.6-58.2, <0.001), type of coronary procedure (85.2, 73.4-97.0, <0.001 for percutaneous coronary intervention vs. coronary angiography), number of interventions and number of additional procedures performed. Among additional procedures, rotablation, intravascular ultrasound and Angiojet were associated with increased contrast use. No significant independent effect on the contrast amount was observed with percutaneous coronary intervention location (right coronary artery vs. left anterior descending artery vs. circumflex artery) site (ostial vs. proximal vs. mid vs. distal) of percutaneous coronary intervention or with interventions on chronic total occlusions on the contrast amount.
Conclusion:
Data from our study could guide the coronary angiographer in moderating the volume of contrast utilized as well as assist with the elective planning of complex therapeutic procedures.
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