title: Meta-analysis of the effect of automated contrast injection devices versus manual injection and contrast volume on risk of contrast-induced nephropathy.
abstract: Contrast-sparing devices have been slowly adopted into routine patient care. Randomized trial evidence of automated contrast injectors (ACIs) has not been analyzed to evaluate the true reduction in contrast volume during coronary angiography and intervention. It has been thought that reducing the amount of contrast exposure will result in a simultaneous reduction in the risk of contrast-induced nephropathy (CIN). Therefore, we sought to synthesize published evidence on contrast-sparing devices, contrast volume, and the incidence of CIN. We searched Medline, the Cochrane Library, and Clinicaltrials.gov. The search criteria included ACIs versus manual injection, contrast media volume, and the incidence of CIN. Data were extracted by 2 independent reviewers. The weighted mean difference of contrast volume was calculated using random effects models in RevMan, version 5.4.1, software to derive a summary estimate. A total of 79,694 patients from 10 studies were included (ACI arm, n = 20,099; manual injection arm, n = 59,595). On average, ACIs reduced contrast volume delivery by 45 ml/case (p <0.001, 95% confidence interval -54 to -35). The CIN incidence was significantly reduced by 15%, with an odds ratio of 0.85 (p <0.001, 95% confidence interval 0.78 to 0.93) for those using ACIs compared with manual injection. In conclusion, the use of ACIs in angiography significantly reduces the volume of contrast delivered to the patient and the incidence of CIN.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Kristopher D
authors.initials: KD
authors.lastname: Minsinger
authors.affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Hayah M
authors.initials: HM
authors.lastname: Kassis
authors.affiliation: Section of Nephrology and Hypertension, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Clay A
authors.initials: CA
authors.lastname: Block
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Audrey and Theodor Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sidhu
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Audrey and Theodor Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: jeremiah.r.brown@dartmouth.edu.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D014943:Global Health; D006801:Humans; D015994:Incidence; D007267:Injections / Q000295:instrumentation; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D003287:Contrast Media