Maladies cardiovasculaires et diagnostic

The Achievability of Minimum Contrast Procedures for the Prevention of Contrast Induced Nephropathy in Patients with Chronic Kidney Disease: A Prospective, Multicentre Trial

Abstract

Yoshiaki Kawase, Hitoshi Matsuo, Tomohiko Teramoto, Osamu Matsuda, Yoriyasu Suzuki, Etsuo Tsuchikane and Takahiko Suzuki

Background The practical utility of minimum contrast procedures in a real world setting is unclear. In this trial, the reality of this strategy was investigated. Methods Patients with an estimated glomerular filtration rate (eGFR) of <=45 ml/min/1.73m2 were included in this study with dates ranging from Jan 17th 2012 to Oct 8th 2013. Various methods to minimize the amount of contrast media were applied. An achievement rate of contrast volume/eGFR<2.0 was calculated and the characteristics of the patients and catheter procedures were investigated. Results A total of 88 patients were enrolled. There were 34 patients who underwent a diagnostic coronary angiogram (CAG group) and 54 patients who underwent an interventional procedure (PCI group). The PCI group tended to use a larger amount of contrast media compared to the CAG group (39 ± 49 ml vs 25 ± 14 ml, p=0.06). A ratio of contrast volume to eGFR of less than 2.0 was achieved in 100% of the CAG group but in only 82% of the PCI group. The patients with complex procedures (complex PCI) such as use of a rotablator and treatment of chronic total occlusion used significantly more contrast media than patients with other procedures (simple PCI). (87 ± 69 ml vs 23 ± 27 ml, p=0.006) Surprisingly, when simple PCI group was compared to the CAG group, there was no difference in the contrast volume used. (23 ± 27 vs 25 ± 14 ml, p=0.708) Conclusions Simple PCI can be done as safely as in CAG patients with chronic kidney dysfunction. Complex PCI should be done with careful assessment of the balance between risk and benefit.