title: Reduction in Contrast Nephropathy From Coronary Angiography and Percutaneous Coronary Intervention With Ultra-Low Contrast Delivery Using an Automated Contrast Injector System.
abstract: OBJECTIVE
  To evaluate the incidence of contrast-induced nephropathy (CIN) following coronary angiography and percutaneous coronary intervention (PCI) utilizing a novel ultra-low contrast delivery (ULCD) technique.
  
  
  BACKGROUND
  Current techniques for reducing contrast volumes during angiographic and PCI procedures require the use of advanced coronary imaging methods, such as intravascular ultrasound and coronary flow wires. We propose the use of an automated contrast injector system (ACIS) with a novel programming technique that significantly reduces contrast volumes and CIN development.
  
  
  METHODS
  From 2013 to 2014, a total of 123 patients with stage III or higher chronic kidney disease (CKD) underwent coronary angiography, PCI, or a combined procedure using the ULCD technique. A retrospective analysis was conducted to evaluate contrast volumes and rate of CIN development. Patients developing CIN were compared using tests of proportions.
  
  
  RESULTS
  The median contrast volume was 17.9 mL (n = 123). The study cohorts comprised diagnostic (15.2 mL; n = 72), PCI (17.1 mL; n = 30), and PCI + diagnostic groups (27.9 mL; n = 21). The incidence of CIN observed in the entire cohort through day 7 was 3.3% (4/123). Seventy-five percent of the CIN cases occurred following diagnostic angiography alone. Longitudinal follow-up at 21 days identified an additional 5 cases of CIN. Compared to literature data, the ULCD technique delivers less contrast per case.
  
  
  CONCLUSIONS
  The adaptation of the ULCD technique for coronary procedures significantly reduces contrast volume delivery when compared with conventional practice or previously described low-contrast techniques. The ULCD appears to be an efficacious method of limiting CIN development in a susceptible population with CKD.
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Kelly
authors.forename: Shenjing
authors.initials: S
authors.lastname: Li
authors.forename: Tomasz P
authors.initials: TP
authors.lastname: Stys
authors.forename: Paul A
authors.initials: PA
authors.lastname: Thompson
authors.affiliation: University of South Dakota Sanford School of Medicine, 1301 West 18th Street, Route 6004, Sioux Falls, SD 57105 USA. Adam.Stys@Sanfordhealth.org.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Stys
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis; D055502:Secondary Prevention / Q000379:methods; D016896:Treatment Outcome; D014481:United States
chemical_list: D003287:Contrast Media