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Association of less-contrast media with clinical factors in elective percutaneous coronary intervention
Yasuhiro Mukai1, Kenichi Sakakura2, Kei Yamamoto1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
Insights
Reducing contrast media during percutaneous coronary intervention (PCI) is linked to patient renal function. Lower contrast use was significantly associated with severely impaired kidney function (eGFR < 30 mL/min/1.73 m²) and complex lesion characteristics.
Area of Science:
- Cardiology
- Nephrology
- Interventional Radiology
Background:
- Contrast media administration during percutaneous coronary intervention (PCI) is associated with contrast-induced nephropathy.
- Minimizing contrast volume is crucial for preserving renal function in patients undergoing PCI.
Purpose of the Study:
- To investigate the clinical factors associated with reduced contrast media usage during elective PCI.
- To identify patient and lesion characteristics that correlate with lower contrast volumes in PCI procedures.
Main Methods:
- Retrospective study of 709 patients undergoing elective PCI.
- Patients categorized into "less-contrast media" (n=142) and "conventional-contrast media" (n=567) groups based on contrast volume quintiles.
- Multivariate logistic regression analysis employed to identify significant associations, with a high intravascular ultrasound (IVUS) utilization rate (94.9%).
Main Results:
- Severely reduced estimated glomerular filtration rate (eGFR < 30 mL/min/1.73 m²) without hemodialysis was strongly associated with the less-contrast media group (OR 43.73, P < 0.001).
- Complex coronary lesion characteristics, including left main-left anterior descending artery lesions, bifurcation lesions, and chronic total occlusions, were inversely associated with less-contrast media usage.
- These findings suggest that pre-procedural knowledge of renal function and lesion complexity influences contrast media management.
Conclusions:
- Complex coronary lesion characteristics are inversely associated with reduced contrast media use in elective PCI.
- Pre-procedural assessment of renal function, particularly eGFR < 30 mL/min/1.73 m², is a significant predictor for lower contrast media administration.
- The study indicates that contrast media volume is controllable during PCI, especially when guided by IVUS, allowing for tailored approaches based on patient factors.
Abstract:
Since the amount of contrast media during percutaneous coronary intervention (PCI) is closely related to the exacerbation of renal function, it should be important to reduce the dose of contrast media during PCI. The purpose of this retrospective study was to evaluate the association of less-contrast media with clinical factors in elective PCI. A total of 709 patients were divided into the less-contrast media group (n = 142) and the conventional-contrast media group (n = 567) according to the quintile of total contrast volume. Univariate and multivariate logistic regression analyses were performed to find associations between the clinical variables and the less-contrast media group. The intravascular ultrasound (IVUS) use rate in the study population was considerably high (94.9%). In multivariable logistic regression analysis, an eGFR < 30 mL/min/1.73 m2 without hemodialysis was significantly associated with the less-contrast media group [odds ratio (OR) 43.73, 95% confidence interval (CI) 14.05-136.09, P < 0.001]. Left main-left anterior descending artery lesion (OR 0.28, 95% CI 0.17-0.48, P < 0.001), bifurcation lesion (OR 0.39, 95% CI 0.16-0.92, P = 0.03), chronic total occlusion (OR 0.22, 95% CI 0.06-0.90, P = 0.03) were inversely associated with the less-contrast media group. In conclusion, complex lesion characteristics were inversely associated with the less-contrast media in elective PCI. Since operators could access patients' renal function before elective procedure, an eGFR < 30 mL/min/1.73 m2 was most significantly associated with the less-contrast media. Our results suggest the possibility that the amount of contrast media is controllable in current PCI under IVUS-guidance.
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