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Contrast volume use in manual vs automated contrast injection systems for diagnostic coronary angiography and
Joshua R Hwang1, Sabrina D'Alfonso, William J Kostuk
1Department of Medicine, Western University, London, Ontario, Canada.
Insights
Automated contrast injection systems did not reduce contrast volume in cardiac procedures. Smaller catheters may decrease contrast volume, potentially impacting contrast-induced nephropathy risk.
Area of Science:
- Cardiology
- Radiology
- Nephrology
Background:
- Contrast-induced nephropathy (CIN) is a significant cause of iatrogenic harm.
- Contrast volume is a key factor in CIN development and is operator-dependent.
- Automated contrast injection systems were hypothesized to reduce contrast volume, but evidence is limited, especially with smaller contrast amounts and varying training levels.
Purpose of the Study:
- To evaluate if automated contrast injection systems reduce contrast volume compared to manual injection.
- To assess the impact of automated systems on contrast volume in diagnostic catheterization and percutaneous coronary intervention (PCI).
- To explore the relationship between catheter size, contrast volume, and CIN incidence.
Main Methods:
- A retrospective study of 1358 patients undergoing diagnostic catheterization and PCI.
- Patients were categorized into manual stopcock-manifold contrast injection (1052 patients) or automated contrast injection (306 patients) groups.
- Contrast media volume was measured, and CIN incidence was assessed, particularly in PCI patients.
Main Results:
- No significant difference in contrast volume was observed between manual and automated injection systems across various procedures (diagnostic catheterization, PCI).
- Contrast volumes for diagnostic catheterization: 72±40 mL (manual) vs. 96±63 mL (automated), P=0.08.
- Contrast volumes for PCI: 206±82 mL (manual) vs. 205±90 mL (automated), P=0.84.
- No significant difference in CIN incidence was found between manual and automated systems in PCI patients (9.8% vs. 7.4%, P=0.43).
- Smaller catheter sizes were significantly associated with lower contrast volume injection (P < 0.0001).
Conclusions:
- Automated contrast injection systems do not appear to reduce contrast volume in diagnostic catheterization and PCI compared to manual injection.
- The use of smaller calibre catheters is associated with reduced contrast volume.
- Further research may be needed to optimize contrast delivery and minimize CIN risk.
Background:
Contrast-induced nephropathy (CIN) is an important cause of iatrogenic morbidity and mortality. The amount of contrast delivered has a major effect on CIN and is operator-dependent. A few studies suggested that the use of automated contrast injection systems is associated with reduced contrast volume. It is unknown whether this is true when smaller amounts of contrast are used and how this is affected by training.
Methods:
Volume of contrast media was measured in 1358 consecutive patients undergoing diagnostic catheterization and percutaneous coronary intervention (PCI) from January 31 to May 31, 2011. Patients were allocated to manual stopcock-manifold contrast injection (1052 patients) or automated contrast injection (306 patients).
Results:
No significant difference in contrast volume use was found between manual and automated contrast injection systems, respectively: diagnostic catheterization, 72 ± 40 mL vs 96 ± 63 mL (P = 0.08); diagnostic catheterization with left ventricular angiography, 98 ± 40 mL vs 95 ± 35 mL (P = 0.51); PCI, 206 ± 82 mL vs 205 ± 90 mL (P = 0.84); diagnostic catheterization and PCI, 264 ± 83 mL vs 253 ± 93 mL (P = 0.51). No significant difference in CIN incidence, according to contrast injection systems, was found among patients receiving PCI (manual 9.8% vs automated 7.4%, P = 0.43). Using smaller sized catheters during diagnostic procedures was associated with injection of smaller amounts of contrast (P < 0.0001).
Conclusions:
The use of automated contrast injection for diagnostic catheterization and PCI is not associated with reduced contrast volume as compared with manual injection. The use of smaller calibre catheters might reduce contrast volume.
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