Determinants of amount of contrast utilized in patients undergoing percutaneous coronary procedures.
OBJECTIVE
To determine predictors of contrast amount during coronary angiography and percutaneous coronary intervention.


BACKGROUND
Contrast-induced nephropathy is a leading cause of hospital-acquired acute renal insufficiency. During percutaneous coronary procedures, contrast amount is a major risk factor incriminated in development of contrast-induced nephropathy.


METHODS
Demographic and procedural details were obtained for consecutive patients undergoing percutaneous coronary procedures between January 2002 and October 2005 (N=962, mean+/-standard error of contrast amount: 216.6+/-3.0 ml) at a tertiary care hospital.


RESULTS
A significant difference (P value <0.05) in unadjusted mean contrast volume was observed between subgroups of percutaneous coronary intervention vs. coronary angiography, patients with a history of coronary artery bypass grafting, patients undergoing additional procedures and multivessel and multisite percutaneous coronary interventions. On General Linear Model analysis, independent predictors (beta coefficient, 95% confidence interval, P value) of increased contrast amount during percutaneous coronary procedures were history of coronary artery bypass grafting (44.4, 30.6-58.2, <0.001), type of coronary procedure (85.2, 73.4-97.0, <0.001 for percutaneous coronary intervention vs. coronary angiography), number of interventions and number of additional procedures performed. Among additional procedures, rotablation, intravascular ultrasound and Angiojet were associated with increased contrast use. No significant independent effect on the contrast amount was observed with percutaneous coronary intervention location (right coronary artery vs. left anterior descending artery vs. circumflex artery) site (ostial vs. proximal vs. mid vs. distal) of percutaneous coronary intervention or with interventions on chronic total occlusions on the contrast amount.


CONCLUSIONS
Data from our study could guide the coronary angiographer in moderating the volume of contrast utilized as well as assist with the elective planning of complex therapeutic procedures.
Pradhan
Jyotiranjan
J
Harper University Hospital, Wayne State University, Detroit Medical center, Detroit, Michigan, USA.
Niraj
Ashutosh
A
Afonso
Luis
L
D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects / Q000592:standards*; D017023:Coronary Angiography / Q000009:adverse effects / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009401:Nephrosis / Q000139:chemically induced / Q000517:prevention & control
D003287:Contrast Media