Related Experiment Videos
Safety of cardiac angiography with conventional ionic contrast agents. The Philadelphia Area Contrast Agent Study
J W Hirshfeld1, W G Kussmaul, P M DiBattiste
1Cardiac Catheterization Laboratory, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia 19104.
Insights
Adverse reactions to conventional ionic contrast agents during cardiac angiography are infrequent. Most reactions are minor, and major events are rare, with no deaths reported in this study.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Conventional ionic contrast agents are widely used in cardiac angiography.
- Patient populations undergoing these procedures often have severe or unstable cardiac disease.
Purpose of the Study:
- To determine the frequency of adverse reactions to conventional ionic contrast agents.
- To identify patient factors associated with increased adverse reaction rates.
Main Methods:
- Retrospective analysis of 4,630 diagnostic cardiac angiographic procedures.
- Data collection on patient characteristics and adverse events.
Main Results:
- Overall minor adverse reaction rate was 14.2%.
- Major adverse reactions occurred in 1.3% of procedures, with successful management and no deaths.
- Adverse reactions were more common in patients with higher New York Heart Association (NYHA) classes and elevated left ventricular end-diastolic pressure.
Conclusions:
- Cardiac angiography with conventional ionic contrast agents is generally safe in a monitored setting.
- Operator caution and appropriate management are key to patient safety.
- Procedure modification or abbreviation occurred in some cases due to adverse reactions or concerns.
Abstract:
To characterize the frequency of adverse reactions to conventional ionic contrast agents, data describing the frequency of such reactions were gathered from 4,630 diagnostic cardiac angiographic procedures. The patient population had a large prevalence of severe or unstable cardiac disease (56% had New York Heart Association class III, IV or V, 12.6% had left ventricular end-diastolic pressure greater than 25 mm Hg and 34% had 3-vessel or left main coronary artery disease). The overall minor adverse reaction rate was 14.2%. Major adverse reactions (requiring treatment) occurred in 61 (1.3%) of procedures. All adverse reactions were managed successfully and there were no deaths. Adverse reactions were more frequent in patients with higher New York Heart Association classes and with elevated left ventricular end-diastolic pressure. The adverse reaction rate was not increased in patients with more extensive coronary artery disease, reduced left ventricular ejection fraction or reduced cardiac index. The overall adverse reaction rate was probably influenced by physician behavior. Smaller volumes of contrast agent were administered to patients with more severe cardiac disease. Six percent of procedures were abbreviated either because of an adverse reaction or of concern that a reaction might occur if the procedure were continued. As a result, the diagnostic data obtained were judged to be inadequate in 0.8% of procedures. These data demonstrate that appropriate operator caution within the highly monitored environment of the cardiac catheterization laboratory allows cardiac angiography to be performed safely with conventional ionic contrast agents in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)