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Major Adverse Renal and Cardiovascular Events following Intra-Arterial Contrast Media Administration in Hospitalized

Peter McCullough1, Chaan S Ng2, Michael Ryan3

  • 1Texas A & M University College of Medicine, Baylor Dallas Campus, Dallas, Texas, USA.

Cardiorenal Medicine
|August 25, 2021
PubMed

Insights

Iso-osmolar contrast media (IOCM) use is linked to fewer adverse renal and cardiovascular events compared to low-osmolar contrast media (LOCM) in high-risk patients. This real-world data confirms IOCM

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Radiology

Background:

  • Clinical studies suggest iso-osmolar contrast media (IOCM) may reduce adverse renal and cardiovascular outcomes compared to low-osmolar contrast media (LOCM).
  • Real-world data is needed to confirm these findings in high-risk patients undergoing intra-arterial procedures, particularly those with comorbidities.
  • Major Adverse Renal and Cardiovascular Events (MARCE) association with contrast type in at-risk populations requires robust analysis.

Purpose of the Study:

  • To retrospectively assess and compare MARCE rates between IOCM and LOCM in at-risk patients receiving iodinated intra-arterial contrast media.
  • To analyze real-world inpatient data to validate the safety profile of IOCM versus LOCM in specific comorbid patient subgroups.

Main Methods:

  • Utilized the Premier Healthcare Database to identify patients undergoing procedures with intra-arterial IOCM or LOCM.
  • Formed patient subgroups based on comorbidities: diabetes, heart failure, chronic kidney disease (CKD) stages 1-4, CKD 3-4, and chronic total occlusion (CTO).
  • Compared MARCE (composite of AKI, dialysis, myocardial infarction, stroke, stent occlusion, death) using multivariable regression analysis.

Main Results:

  • In a cohort of 536,013 inpatient visits, IOCM use was associated with significantly lower MARCE rates than LOCM in patients with CKD 1-4, CKD 3-4, diabetes, or heart failure.
  • Greatest absolute risk reduction (ARR) of 2.4% was observed in CKD 3-4 patients (NNT=43), with further ARR of 3.5% in combined diabetes and CKD 3-4 (NNT=29).
  • Significant risk reduction was also noted for IOCM in patients with CTO revascularization (ARR=1.6%, NNT=62).

Conclusions:

  • Intra-arterial IOCM administration is associated with reduced MARCE rates compared to LOCM in at-risk patient populations.
  • The benefits of IOCM are particularly pronounced in patients with combined diabetes and CKD 3-4, and in those undergoing CTO revascularization.
  • This real-world evidence supports the use of IOCM for improved outcomes in vulnerable patients undergoing intra-arterial procedures.
Abstract

Keywords:
Chronic kidney diseaseChronic total occlusionContrast mediaMajor adverse cardiovascular eventsMajor adverse renal events

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