Cardiac events after low osmolar ionic or isosmolar nonionic contrast media utilization in the current era of coronary angioplasty.
OBJECTIVE
Our study aimed to compare the isosmolar nonionic dimer iodixanol and the low osmolar ionic agent ioxaglate in the current era of percutaneous coronary intervention (PCI), using clopidogrel, enoxaparine, direct stenting, and drug eluting stent.


BACKGROUND
Previous studies have suggested an association between thrombus-related events and type of contrast media.


METHODS
Our prospective single-center study included 498 consecutive patients who were assigned to receive either iodixanol (n = 231) or ioxaglate (n = 267). The primary endpoint was the cumulative rate of in-hospital major adverse clinical events (MACE). A secondary endpoint was the rate of angiographic or procedural complications.


RESULTS
Clinical and angiographic baseline characteristics and procedural data were similar in the 2 groups. A peak anti-Xa > 0.5 IU/ml was obtained in 97% in both groups. Glycoprotein IIb/IIIa inhibitors were used in 42% of patients. Coronary stenting was performed in 91% of patients, with direct stenting in 70%, and drug-eluting stent in 28% of patients. In-hospital MACE was more frequent in patients receiving iodixanol compared with those receiving ioxaglate (4.8% vs. 0.3%, P < 0.005). This difference was mainly related to the appearance of a large thrombus during PCI (6% with iodixanol vs. 0.3% with ioxaglate, P < 0.0001). In multivariate analysis, independent predictors of in-hospital MACE were use of iodixanol (P < 0.01), the higher number of stent used (P < 0.008), bifurcation/ostial lesion (P < 0.01), and balloon dilation before stenting (p < 0.001).


CONCLUSIONS
In our study reflecting the current era of PCI, thrombus-related events are more frequent with the isosmolar nonionic dimer iodixanol than with the low osmolar ionic agent ioxaglate.
Le Feuvre
Claude
C
Cardiology Department, Pitié-Salpêtrière Hospital, 47 et 83 Bd de l'Hôpital, 75651 Paris cedex 13, France. claude.lefeurvre@psl.ap-hop-paris.fr
Batisse
Anne
A
Collet
Jean P
JP
Batisse
Jean P
JP
Choussat
Rémy
R
Beygui
Farzin
F
Helft
Gérard
G
Montalescot
Gilles
G
Metzger
Jean P
JP
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D000077144:Clopidogrel; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D017023:Coronary Angiography; D016503:Drug Delivery Systems; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007485:Ioxaglic Acid / Q000009:adverse effects / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014283:Triiodobenzoic Acids / Q000009:adverse effects / Q000737:chemistry
D003287:Contrast Media; D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D014283:Triiodobenzoic Acids; D000077144:Clopidogrel; C044834:iodixanol; D013988:Ticlopidine; D007485:Ioxaglic Acid