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Choice of contrast medium in patients with impaired renal function undergoing percutaneous coronary intervention

Rainer Wessely1, Tobias Koppara, Christian Bradaric

  • 1Deutsches Herzzentrum and 1 Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany. rwessely@web.de

Circulation. Cardiovascular Interventions
|December 25, 2009
PubMed

Insights

This study found no significant difference in contrast-mediated nephrotoxicity between iso-osmolar and low-osmolar contrast media in patients with chronic renal failure undergoing percutaneous coronary intervention (PCI). However, iodixanol showed potential benefits with higher contrast volumes.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Contrast-mediated nephrotoxicity is a concern in patients with chronic renal failure undergoing percutaneous coronary intervention (PCI).
  • No prior clinical trials exclusively focused on this high-risk population.

Purpose of the Study:

  • To compare the incidence of contrast-mediated nephrotoxicity between iso-osmolar (iodixanol) and low-osmolar (iomeprol) contrast media.
  • To evaluate the safety of contemporary contrast media in patients with chronic renal failure undergoing PCI.

Main Methods:

  • A prospective, randomized, double-blind, comparative clinical trial.
  • 939 patients with chronic renal failure undergoing coronary angiography with potential PCI were randomized.
  • 324 patients undergoing PCI were analyzed, receiving either iodixanol or iomeprol.

Main Results:

  • The peak increase in serum creatinine after PCI was not significantly different between iodixanol and iomeprol groups (P=0.53).
  • Contrast media-induced nephropathy rates were 22.2% for iodixanol and 27.8% for iomeprol, a non-significant difference (P=0.25).
  • Subgroup analysis indicated a potential benefit of iodixanol in patients receiving higher contrast volumes (>340 mL) (P(interaction)=0.016).

Conclusions:

  • Routine use of iso-osmolar contrast media (iodixanol) does not significantly reduce nephrotoxicity compared to low-osmolar media (iomeprol) in this patient group.
  • A potential favorable effect of iodixanol was observed in patients receiving high contrast volumes, warranting further investigation.
  • Further randomized trials are needed to confirm these findings.
Abstract

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