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Iohexol, ioxaglate and iopamidol in coronary angiography. A double-blind comparative study of 300 patients
1Department of Diagnostic Radiology, Meilahti Hospital, Helsinki University Central Hospital.
Insights
This study compared three low osmolar contrast media for coronary angiography. Ioxaglate showed more electrocardiographic changes and mild side effects compared to iohexol and iopamidol.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Coronary angiography requires contrast media.
- Evaluating the safety and cardiac effects of different contrast media is crucial.
Purpose of the Study:
- To compare the clinical safety and electrocardiographic (ECG) changes of three low osmolar contrast media: iohexol 300, ioxaglate 320, and iopamidol 300.
- To assess adverse reactions associated with these agents during coronary angiography.
Main Methods:
- A randomized, double-blind study involving 300 patients undergoing coronary angiography.
- Continuous monitoring of ECG (lead V5/V6 or AVF) and intra-arterial pressure before and after contrast injection.
- Statistical analysis of variables including QT interval, heart rate, ST segment depression, and adverse events.
Main Results:
- Ioxaglate group showed a significant increase in QT interval (p=0.001) and more marked ST segment depression during right (p=0.0001) and left (p=0.04) coronary angiography.
- Heart rate decreased in all groups, with a slightly smaller decrease in the ioxaglate group (p=0.02).
- Ioxaglate caused mild side effects in 16% of patients (nausea, vomiting, urticaria), while iohexol and iopamidol caused side effects in 1%.
Conclusions:
- Ioxaglate 320 demonstrated a less favorable safety profile regarding ECG changes and mild adverse effects compared to iohexol 300 and iopamidol 300.
- Iohexol and iopamidol appear to be safer alternatives for coronary angiography with fewer associated side effects.
Abstract:
A randomized, double-blind study was carried out in 300 consecutive coronary angiography examinations to investigate the clinical safety of three low osmolar contrast media, iohexol 300, ioxaglate 320 and iopamidol 300, and the electrocardiographic changes that occurred with them. The ECG from electrode V5/V6 or AVF and intra-arterial pressure were monitored continuously, and recorded before and after the first contrast injections into the left and right coronary arteries. Of the variables tested, no statistically significant changes occurred in systolic arterial pressure, PR interval or ventricular extrasystole. The QT interval increased in the ioxaglate group (p = 0.001). Heart rate decreased in all groups, but slightly less in the ioxaglate group than in the iopamidol group (p = 0.02). The ST segment depression (mean 0.67m) was more marked in the ioxaglate group than in the other treatment groups (p = 0.0001) during right coronary angiography. The same characteristics, but less marked, were observed during left coronary angiography, the ioxaglate group (mean 0.251mm) differing from the iopamidol group (mean 0.050mm) (p = 0.04). No significant difference in severe adverse reactions were detected between these groups (ioxaglate 1, iopamidol 1). Ioxaglate produced mild side effects (nausea, vomitus, urticaria) in 16% of the patients, the other two contrast agents producing side effects in 1%.