title: Impact of automated contrast injector systems on contrast use and contrast-associated complications in patients undergoing percutaneous coronary interventions.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of manual versus automated contrast injection on renal complications in patients undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Contrast volume is a major modifiable risk factor for contrast-induced nephropathy (CIN). Automated contrast injector systems (ACIS) are believed to be associated with a reduction in the total volume of contrast media use.
  
  
  METHODS
  We compared the outcome of 60,884 patients who underwent PCI at 28 hospitals in Michigan in 2008 to 2009 and assessed the outcome of those treated at hospitals that did not use ACIS (n = 24) and compared them with those that used ACIS (n = 4). Propensity matching was used to adjust for baseline differences.
  
  
  RESULTS
  The use of ACIS was associated with a statistically significant albeit clinically small difference in the average volume of contrast media use (mean 199 ± 84 ml vs. mean 204 ± 82 ml, p < 0.0001) with no difference in proportion of patients exceeding contrast volume/calculated creatinine clearance ratio of 3 (28.4% vs. 29.1%, p = 0.19). There was no difference in the incidence of CIN (3.11% vs. 3.42%, p = 0.15) or new need for dialysis (0.30% vs. 0.33%, p = 0.54), and these differences remained nonsignificant in propensity matched analysis. In fully adjusted, multivariate logistic analysis, patients treated with ACIS remained as likely to develop CIN (odds ratio: 0.96, 95% confidence interval: 0.83 to 1.11, p = 0.56) or new need for dialysis (odds ratio: 0.83, 95% confidence interval: 0.54 to 1.28, p = 0.40).
  
  
  CONCLUSIONS
  Compared with hospitals using manual injection, institutions having ACIS used slightly less amount of contrast with no reduction in CIN. Use of ACIS is unlikely to impact contrast-induced renal complications in patients undergoing PCI.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-5869, USA. hgurm@med.umich.edu
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.forename: Dean
authors.initials: D
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.forename: David
authors.initials: D
authors.lastname: Wohns
authors.forename: John
authors.initials: J
authors.lastname: Collins
authors.forename: Mohan
authors.initials: M
authors.lastname: Madala
authors.forename: Srinivas
authors.initials: S
authors.lastname: Koneru
authors.forename: Dan
authors.initials: D
authors.lastname: Menees
authors.forename: Stanley
authors.initials: S
authors.lastname: Chetcuti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007267:Injections; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D015641:Radiography, Interventional / Q000295:instrumentation*; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine