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Published on: July 19, 2011
Contemporary contrast media dosing during percutaneous coronary intervention in patients with pre-existing renal
Devika Aggarwal1, Rebecca Young2, Milan Seth3
1Mount Sinai Fuster Heart, Mount Sinai Morningside Hospital, New York, New York.
Insights
High contrast volume during percutaneous coronary intervention (PCI) increases acute kidney injury (AKI) risk and dialysis need. Using contrast volume less than 3 times the estimated glomerular filtration rate (eGFR) is recommended for safer PCI procedures.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Acute kidney injury (AKI) is a risk following percutaneous coronary intervention (PCI).
- Minimizing contrast volume can reduce AKI risk, but current dosing patterns are not well understood.
- Patients with pre-existing renal impairment are particularly vulnerable.
Purpose of the Study:
- To assess contrast volume dosing patterns in patients undergoing PCI with impaired renal function.
- To evaluate the association between contrast volume and AKI incidence and severity.
- To determine the impact of contrast volume on the need for dialysis.
Main Methods:
- Analysis of 463,753 patients from the NCDR CathPCI registry with eGFR ≤ 60 mL/min/1.73 m2.
- Patients categorized by contrast volume relative to eGFR: high (>3), low (1-3), and ultra-low (<1).
- Primary outcome: AKI occurrence, adjusted for validated prediction model covariates.
Main Results:
- 51.4% of patients received high contrast volume.
- High contrast volume was linked to significantly higher AKI incidence (aOR 1.36) and severity (aOR 1.90) compared to low volume.
- New need for dialysis was higher with high contrast volume (2.8%) versus low (0.8%) and ultra-low (0.8%).
Conclusions:
- High contrast volume during PCI is associated with adverse outcomes, including AKI and new dialysis requirement.
- Contrast volume less than 3 times eGFR is a beneficial target for guiding PCI contrast dosing.
- These findings support optimizing contrast administration to improve patient safety in PCI.
Objectives:
Contrast volume minimization can mitigate acute kidney injury (AKI) risk following percutaneous coronary intervention (PCI), but national data regarding contemporary contrast volume dosing patterns are lacking. The authors analyzed data from the National Cardiovascular Data Registry (NCDR) CathPCI registry to assess the prevalence and outcomes of renal function-based contrast dosing during PCI in patients with pre-existing renal impairment.
Methods:
The authors analyzed data from 463 753 patients with an eGFR ≤ 60 mL/min/1.73 m2, and categorized patients based on contrast volume/eGFR: high (> 3), low (1-3), and ultra-low (less than 1). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. The primary outcome was occurrence of AKI. Outcomes were adjusted based on covariates derived from a validated AKI prediction model.
Results:
The majority (51.4%) of patients received high contrast volume. Compared with patients who received low contrast volume, patients with high contrast volume use had a significantly higher incidence of AKI (adjusted OR 1.36 [1.28 to 1.45]) and a higher stage of AKI (adjusted OR 1.90 [1.80 to 2.00]). The incidence of AKI was similar between low and ultra-low contrast volume use. The development of new need for dialysis was higher in patients who received high contrast volume (2.8%) compared with those who received low contrast volume (0.8%) and ultra-low contrast volume (0.8%) (P less than .001).
Conclusions:
High contrast volume during PCI is associated with worse outcomes including AKI and new need for dialysis. Our study provides further support for the use of contrast volume less than 3 times the eGFR as a target to guide contrast dosing during PCI.
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