Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Cardiology Journal
MENU
Shortcuts Submit an article CJ Guide for Authors (new) Recent articles Special collections Ahead Of Print APIS-S Online Calculator OCT Contrast Calculator Reviewers 2022

open access

Ahead of print
Original Article
Submitted: 2021-09-15
Accepted: 2021-12-03
Published online: 2021-12-17
View PDF Download PDF file Supp./Additional Files [1]
Get Citation

Different outcomes between iso-osmolar and low-osmolar contrast media in acute myocardial infarction with renal impairment

Seok Oh1, Ji Sung Kim1, Youngkeun Ahn1, Joon Ho Ahn1, Dae Young Hyun1, Seung Hun Lee1, Kyung Hoon Cho1, Min Chul Kim1, Doo Sun Sim1, Young Joon Hong1, Ju Han Kim1, Myung Ho Jeong1
DOI: 10.5603/CJ.a2021.0171
·
Pubmed: 34931692
Affiliations
  1. Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea

open access

Ahead of print
Original articles
Submitted: 2021-09-15
Accepted: 2021-12-03
Published online: 2021-12-17

Abstract

Background: The selection of appropriate contrast media (CM) remains an important issue in terms of renal preservation in patients with acute myocardial infarction (AMI) and renal impairment scheduled for percutaneous coronary intervention (PCI). We compared the clinical outcomes of patients with AMI and renal impairment, depending on the CM type (iso-osmolar CM [IOCM] vs. low-osmolar CM [LOCM]) that was used during PCI.

Methods: From the Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction, 3174 post-PCI patients with AMI and renal impairment were subdivided into two groups (IOCM [n = 2101] and LOCM [n = 1073]).

Results: Regarding in-hospital clinical outcomes, the IOCM group had a higher peak creatinine (Cr) level and lower “Cr differential” than the LOCM group. A higher proportion of dialysis was noted in the IOCM group. In 30-day clinical outcomes, the IOCM group showed higher incidence of new-onset heart failure (HF) but lower incidence of revascularization than the LOCM group. The differences in in-hospital and 30-day clinical outcomes were attenuated after inverse probability of treatment weighting, except for new-onset HF. All other variables in 30-day clinical outcomes, including all-cause death, non-fatal myocardial infarction, cerebrovascular accidents, stent thrombosis, and any dialysis events, were similar between the two groups.

Conclusions: Iso-osmolar CM use did not prevent future incidence of dialysis compared to LOCM use in AMI patients with renal impairment.

Abstract

Background: The selection of appropriate contrast media (CM) remains an important issue in terms of renal preservation in patients with acute myocardial infarction (AMI) and renal impairment scheduled for percutaneous coronary intervention (PCI). We compared the clinical outcomes of patients with AMI and renal impairment, depending on the CM type (iso-osmolar CM [IOCM] vs. low-osmolar CM [LOCM]) that was used during PCI.

Methods: From the Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction, 3174 post-PCI patients with AMI and renal impairment were subdivided into two groups (IOCM [n = 2101] and LOCM [n = 1073]).

Results: Regarding in-hospital clinical outcomes, the IOCM group had a higher peak creatinine (Cr) level and lower “Cr differential” than the LOCM group. A higher proportion of dialysis was noted in the IOCM group. In 30-day clinical outcomes, the IOCM group showed higher incidence of new-onset heart failure (HF) but lower incidence of revascularization than the LOCM group. The differences in in-hospital and 30-day clinical outcomes were attenuated after inverse probability of treatment weighting, except for new-onset HF. All other variables in 30-day clinical outcomes, including all-cause death, non-fatal myocardial infarction, cerebrovascular accidents, stent thrombosis, and any dialysis events, were similar between the two groups.

Conclusions: Iso-osmolar CM use did not prevent future incidence of dialysis compared to LOCM use in AMI patients with renal impairment.

Full Text:

View PDF Download PDF file Supp./Additional Files [1]
Get Citation

Keywords

myocardial infarction, contrast media, renal dialysis, percutaneous coronary intervention, Korea

Supp./Additional Files (1)
Supplemental Table 1
Download
29KB
About this article
Title

Different outcomes between iso-osmolar and low-osmolar contrast media in acute myocardial infarction with renal impairment

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-12-17

Page views

1326

Article views/downloads

347

DOI

10.5603/CJ.a2021.0171

Pubmed

34931692

Keywords

myocardial infarction
contrast media
renal dialysis
percutaneous coronary intervention
Korea

Authors

Seok Oh
Ji Sung Kim
Youngkeun Ahn
Joon Ho Ahn
Dae Young Hyun
Seung Hun Lee
Kyung Hoon Cho
Min Chul Kim
Doo Sun Sim
Young Joon Hong
Ju Han Kim
Myung Ho Jeong

References (29)
  1. Kim Y, Jeong MHo, Ahn Y, et al. Results of a 10-year experience in Korea using drug-eluting stents during percutaneous coronary intervention for acute myocardial infarction (from the Korea acute myocardial infarction registry). Am J Cardiol. 2018; 122(3): 365–373.
    CrossRefPubMed
  2. Thomsen HS, Morcos SK, Thomsen HS, et al. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. Br J Radiol. 2003; 76(908): 513–518.
    CrossRefPubMed
  3. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997; 103(5): 368–375.
    CrossRefPubMed
  4. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002; 105(19): 2259–2264.
    CrossRefPubMed
  5. Du M, Jiang L, Tang X, et al. Contrast induced nephropathy and 2-year outcomes of iso-osmolar compared with low-osmolar contrast media after elective percutaneous coronary intervention. Korean Circ J. 2021; 51(2): 174–181.
    CrossRefPubMed
  6. McClennan BL. Low-osmolality contrast media: premises and promises. Radiology. 1987; 162(1 Pt 1): 1–8.
    CrossRefPubMed
  7. Thomsen HS, Dorph S. High-osmolar and low-osmolar contrast media. An update on frequency of adverse drug reactions. Acta Radiol. 1993; 34(3): 205–209.
    PubMed
  8. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993; 188(1): 171–178.
    CrossRefPubMed
  9. Chalmers N, Jackson RW. Comparison of iodixanol and iohexol in renal impairment. Br J Radiol. 1999; 72(859): 701–703.
    CrossRefPubMed
  10. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003; 348(6): 491–499.
    CrossRefPubMed
  11. Jo SH, Youn TJ, Koo BK, et al. Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER study: a randomized controlled trial. J Am Coll Cardiol. 2006; 48(5): 924–930.
    CrossRefPubMed
  12. Briguori C, Colombo A, Airoldi F, et al. Nephrotoxicity of low-osmolality versus iso-osmolality contrast agents: impact of N-acetylcysteine. Kidney Int. 2005; 68(5): 2250–2255.
    CrossRefPubMed
  13. Solomon RJ, Natarajan MK, Doucet S, et al. Investigators of the CARE Study. Cardiac Angiography in Renally Impaired Patients (CARE) study: a randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease. Circulation. 2007; 115(25): 3189–3196.
    CrossRefPubMed
  14. McCullough PA, Bertrand ME, Brinker JA, et al. A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. J Am Coll Cardiol. 2006; 48(4): 692–699.
    CrossRefPubMed
  15. Heinrich MC, Häberle L, Müller V, et al. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. Radiology. 2009; 250(1): 68–86.
    CrossRefPubMed
  16. Reed M, Meier P, Tamhane UU, et al. The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2009; 2(7): 645–654.
    CrossRefPubMed
  17. Shin DIl, Chang K, Ahn Y, et al. Impact of occluded culprit arteries on long-term clinical outcome in patients with non-ST-elevation myocardial infarction: 48-month follow-up results in the COREA-AMI Registry. J Interv Cardiol. 2014; 27(1): 12–20.
    CrossRefPubMed
  18. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
    CrossRefPubMed
  19. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16(1): 31–41.
    CrossRefPubMed
  20. McCallum W, Tighiouart H, Kiernan MS, et al. Relation of kidney function decline and NT-proBNP with risk of mortality and readmission in acute decompensated heart failure. Am J Med. 2020; 133(1): 115–122.e2.
    CrossRefPubMed
  21. Bergström A, Andersson B, Edner M, et al. Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function. Results of the Swedish Doppler-echocardiographic study (SWEDIC). Eur J Heart Fail. 2004; 6(4): 453–461.
    CrossRefPubMed
  22. Brophy JM, Joseph L, Rouleau JL. Beta-blockers in congestive heart failure. A Bayesian meta-analysis. Ann Intern Med. 2001; 134(7): 550–560.
    CrossRefPubMed
  23. Klingbeil AU, Schneider M, Martus P, et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med. 2003; 115(1): 41–46.
    CrossRefPubMed
  24. He J, Ogden LG, Bazzano LA, et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001; 161(7): 996–1002.
    CrossRefPubMed
  25. Tsai IT, Wang CP, Lu YC, et al. The burden of major adverse cardiac events in patients with coronary artery disease. BMC Cardiovasc Disord. 2017; 17(1): 1.
    CrossRefPubMed
  26. From AM, Al Badarin FJ, McDonald FS, et al. Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy: meta-analysis of randomized, controlled trials. Circ Cardiovasc Interv. 2010; 3(4): 351–358.
    CrossRefPubMed
  27. Liss P, Persson PB, Hansell P, et al. Renal failure in 57 925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int. 2006; 70(10): 1811–1817.
    CrossRefPubMed
  28. Bettmann MA. Frequently asked questions: iodinated contrast agents. Radiographics. 2004; 24 Suppl 1: S3–10.
    CrossRefPubMed
  29. Ui S, Chino M, Isshiki T. Rates of primary percutaneous coronary intervention worldwide. Circ J. 2005; 69(1): 95–100.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl