Adverse effects of calcium binding contrast agents in diagnostic cardiac angiography. A comparison between formulations with and without calcium binding additives.
OBJECTIVE
The authors compared complications and hemodynamic and electrophysiologic effects of two formulations of diatrizoate, one with additives that bind calcium and one without, in diagnostic cardiac angiography.


METHODS
Two hundred twenty-three consecutive low-risk patients alternately received Hypaque 76 (group 1, little calcium binding effect), and MD 76 (group 2, significant calcium binding). Electrocardiographic and hemodynamic changes related to coronary angiography and left ventriculography were measured, and complications requiring treatment were recorded.


RESULTS
There were more complications in patients in group 2 than in group 1 (18 versus 8, P = 0.04). Arterial pressure fell more, the QT interval increased more, and the heart rate fell more in group 2 after coronary angiography.


CONCLUSIONS
Formulations of diatrizoate that minimize calcium binding are advocated for cardiac angiography when using high osmolality contrast media. The more detrimental effects that calcium binding has on myocardial function and cardiac conduction may lead to the higher incidence of complications.
Matthai
W H
WH
Department of Medicine, UMDNJ/Robert Wood Johnson Medical School, Camden, USA.
Groh
W C
WC
Waxman
H L
HL
Kurnik
P B
PB
D000787:Angina Pectoris / Q000139:chemically induced; D001794:Blood Pressure / Q000187:drug effects; D002118:Calcium / Q000737:chemistry*; D002626:Chemistry, Pharmaceutical; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D017023:Coronary Angiography; D003973:Diatrizoate / Q000009:adverse effects* / Q000737:chemistry; D003974:Diatrizoate Meglumine / Q000009:adverse effects / Q000737:chemistry; D004338:Drug Combinations; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D016277:Ventricular Function, Left / Q000187:drug effects; D017725:Ventricular Pressure / Q000187:drug effects
D003287:Contrast Media; D004338:Drug Combinations; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; C027278:urovision; D002118:Calcium