Percutaneous coronary intervention during the shortage of iodinated contrast

A recent coronavirus-related factory shutdown led to a global shortage of iodinated contrast. The authors evaluated how the contrast shortage impacted percutaneous coronary interventions (PCI).

Using a statewide database incorporating CathPCI registry data from 19 hospitals, the authors evaluated 2 time periods: pre-shortage (May 1, 2021 - April 30, 2022) and during the shortage (May 1, 2022 - October 31, 2022). They compared procedure volumes, patient and procedure characteristics, and short-term outcomes, including acute kidney injury (AKI). Of primary interest was the difference in contrast volume per PCI and the incidence of AKI between periods.

There were 8980 patients treated pre-shortage and 4046 during the shortage. Procedure volumes per hospital remained similar, as did patient characteristics. Multivessel procedures declined during the shortage (45.3% vs 42.8%, P = .007). There was a significant decline in contrast per procedure (149.9 ± 68.1 mL to 137.5 ± 62.4 mL per case, P less than .0001) that began at the start of the shortage and continued throughout. There were no differences in patient outcomes, including AKI (7.9% vs 7.4%, P = .40), between study periods. When limited to patients at increased risk of AKI, there remained no difference in AKI between the study periods, despite a similar decrease in contrast volume in that cohort. Multivariable analysis showed a strong correlation between baseline risk of AKI and subsequent AKI (P less than .0001), but no impact of procedure characteristics or time period.

The global shortage of iodinated contrast led to a significant decline in contrast use during PCI, with no impact on patient outcomes.