J Transcat Intervent.2020;28:eA20190021.
Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention, iso-osmolar non-ionic contrast agent versus low-osmolar ionic contrast agent
Rodrigo de Moura Joaquim
, Rafaela Penalva, Roberto Léo da Silva, Alexandre Abizaid, Sérgio Navarro Braga, Luiz Fernando Tanajura, Amanda Guerra de Moraes Rego Sousa, Fausto Feres, José de Ribamar Costa Júnior
DOI: 10.31160/JOTCI202028A20190021
ABSTRACT
Background
Coronary angiography is an advance in the management of a variety of heart conditions, but iodinated contrast injection can lead to contrast-induced nephropathy, especially in high-risk populations. There is still no consensus on the best type of contrast agent to be used. The objective of this study was to evaluate the occurrence of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention, comparing a low-osmolar contrast agent with an iso-osmolar contrast agent.
Methods
This was a single center, longitudinal, prospective and non-concurrent study. The type of contrast agent used in the procedure and the clinical variables of the patients were associated with the occurrence of contrast-induced nephropathy using the Chi-square test. A logistic regression model was developed for multivariate analysis.
Results
A total of 374 percutaneous coronary interventions were performed with only one type of contrast agent, 275 using a low-osmolar contrast agent, and 99 using an iso-osmolar contrast agent. The mean age was 61.86 years; 66.3% of patients were male, 38.5% were diabetic, 24.3% had chronic kidney disease, and 44.7% had acute coronary syndrome. The iso-osmolar contrast agent was associated with a higher occurrence of nephropathy when compared to the low-osmolar contrast agent (12.1% versus 5.8%; p=0.041; p=0.047 in multivariate analysis), with a 2.3 times greater chance of complication. Age (p=0.045) and diabetes (p=0.088) were also relevant for the occurrence of nephropathy. One patient in each group progressed to hemodialysis during the in-hospital period.
Conclusion
The iso-osmolar non-ionic contrast agent is associated with a higher occurrence of contrast-induced nephropathy when compared to the low-osmolar ionic contrast agent.
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