A Comparison of Nonionic, Low-Osmolality Radiocontrast Agents with Ionic, High-Osmolality Agents during Cardiac Catheterization

Barrett, Brendan; Parfrey, Patrick S.; Vavasour, H; O'Dea, Frank; Kent, Gloria M.; Stone, Eric

doi:10.1056/nejm199202133260702

Cited by 129 publications

(45 citation statements)

References 10 publications

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“…1) Adverse reactions related to nonionic contrast media are estimated at 5-10%. 2,3) These incidence rates are consistent with available data on adverse reactions for non-invasive radiologic procedures. 4) Renal injury from contrast media is widely established and there are a few proposed risk models to predict the risk of renal injury.…”

Section: Discussionsupporting

confidence: 86%

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Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

2018

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SummaryAllergic reactions to contrast media are a frequently reported complication of coronary angiography. The majority of patients experience mild, self-limited episodes, but in rare cases patients may experience severe, persistent symptoms. A strategy of premedication with corticosteroids and anti-histamines and an optimal selection of contrast agent is almost always successful in averting contrast reactions, yet a select few patients will continue to have breakthrough events. This is a case of recurrent, severe allergy to contrast media despite standard precautions complicating the treatment of non-ST elevation myocardial infarction (NSTEMI). Our patient was successfully managed with a strategy of rapid desensitization to iodinated contrast media achieved by administering progressively incremental doses of the media.(Int Heart J Advance Publication) Key words: Coronary artery disease, Chemotoxic reaction, Anaphylactoid reaction M inor allergic reactions to contrast media are a frequently reported complication of coronary angiography though severe allergic reactions are much less common. Such events are typically prevented with premedication and selection of appropriate contrast media prior to the procedure. Here we present a case of refractory, severe allergic reaction to contrast media during coronary angiography that was successfully managed with a desensitization protocol. Case ReportThe patient was a 67-year-old man with a history of non-obstructive coronary artery disease (CAD) diagnosed 3 years previously on a coronary angiogram that demonstrated a 50% stenosis in the mid left anterior descending artery (LAD), pacemaker placement for complete heart block (CHB), asthma and bladder cancer who was initially admitted to our affiliated Veterans Hospital for a planned cystoscopy/retrograde pyelogram. While in recovery in the post-anesthesia care unit he informed his nurse of intra-operative chest pain that had since resolved. An electrocardiogram (ECG) was unchanged from baseline. His first troponin was 0.18. He was started on dual antiplatelet therapy and anticoagulation and continued on his beta-blocker and statin. His troponin peaked at 0.20 the following day. Urgent revascularization for NSTEMI was scheduled for the following morning.Pre-catheterization evaluation revealed a significant history of allergic reaction to contrast media. In early 2013 the patient developed nausea and an erythematous, pruritic rash following a contrast-enhanced CT scan of the abdomen and pelvis. A contrast allergy was added to his medical record. He was scheduled for coronary angiography later that year, and was pretreated with oral prednisone 50 mg (13 hours, 7 hours and 1 hour pre-procedure), as well as oral diphenhydramine (1 hour pre-procedure). Despite pretreatment he developed severe nausea and pruritus, with scattered erythema and bullae noted on exam. He was treated with intravenous methylprednisolone, famotidine, and diphenhydramine, and monitored in the ICU for 2 days. He was hospitalized again in 2014 after develop...

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Section: Discussionsupporting

confidence: 86%

“…2,6) Patients with a known previous history of adverse reaction to contrast media are at the highest risk of repeat reaction on subsequent procedures. Other risk factors thought to increase the risk include persistent asthma, female sex, and prior atopy.…”

Section: )mentioning

confidence: 99%

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

2018

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“…18,19 Nowadays, high-osmolar contrast media have been replaced by low-osmolar and iso-osmolar contrast media because of better tolerability, lower side effects, and, importantly, a lower incidence of CIN. 20,21 It is important to acknowledge that this classification, albeit commonly used, might be confusing because the so-called low-osmolar contrast media are in fact hyperosmolar compared with blood.…”

Section: Clinical Perspective On P 437mentioning

confidence: 99%

Choice of Contrast Medium in Patients With Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Wessely

Koppara

Bradaric

et al. 2009

Circ: Cardiovascular Interventions

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MD; for the Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty (CONTRAST) Trial investigatorsBackground-No clinical trial has yet focused on contrast-mediated nephrotoxicity in patients with chronic renal failure exclusively undergoing percutaneous coronary intervention (PCI). Therefore, the aim of this study was to compare the effect of contemporary contrast media on nephrotoxicity in this high-risk patient population. Methods and Results-This prospective, randomized, double-blind, comparative clinical trial randomly selected 939 patients with chronic renal failure undergoing coronary angiography with potential PCI to receive either the iso-osmolar contrast medium iodixanol or the low-osmolar contrast medium iomeprol. Of those 939 patients, 615 received diagnostic angiography only and were not included in the primary study analysis, but were followed up in a registry. Three hundred twenty-four patients underwent PCI, of which one-half received iodixanol or iomeprol, respectively, and were included in the primary study analysis. The primary end point was the peak increase in S-creatinine during hospitalization for PCI. Maximum increase in S-creatinine after PCI was lower than expected and thus impaired the power of the study. It was not significantly different between the 2 contrast groups (0.19Ϯ0.40 mg/dL for iodixanol and 0.21Ϯ0.34 mg/dL for iomeprol; Pϭ0.53). Albeit contrast media-induced nephropathy rates were lower with iodixanol (22.2% compared with 27.8% for iomeprol), this difference was not statistically different (Pϭ0.25). Subgroup analysis suggested a favorable outcome regarding nephrotoxicity in patients who received higher contrast volumes (Ͼ340 mL) in the iodixanol group (P interaction ϭ0.016). Conclusions-Routine use of iso-osmolar contrast medium is not associated with a significant reduction of nephrotoxicity compared with low-osmolar contrast medium in patients with chronic renal failure undergoing PCI. However, a positive effect was seen in the iso-osmolar contrast group for patients receiving high amounts of contrast medium, which awaits confirmation of a specifically designed randomized clinical trial. Clinical Trial Registration-clinicaltrials.gov Identifier: NCT00390585 (Circ Cardiovasc Intervent. 2009;2:430-437.)

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“…Preexistent low glomerular filtration rate (GFR) and diabetes mellitus 5,[8][9][10] share the strongest evidence as major risk factors. However, age 11 , gender, contrast medium infused volume 9,11,12 and osmolarity 8,[12][13][14][15][16][17][18] , use of angiotensin-converting enzyme (ACE) inhibitors 19 , peripheral artery disease and acute myocardial infarction have also been associated with the development of CIN 4,20,21 .…”

mentioning

confidence: 99%

Há uma associação entre anti-inflamatórios não-esteroides e nefropatia induzida por contraste?

Diogo

Saitovitch²,

Biehl³

et al. 2010

Arq. Bras. Cardiol.

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A Comparison of Nonionic, Low-Osmolality Radiocontrast Agents with Ionic, High-Osmolality Agents during Cardiac Catheterization

Cited by 129 publications

References 10 publications

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography

Choice of Contrast Medium in Patients With Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Há uma associação entre anti-inflamatórios não-esteroides e nefropatia induzida por contraste?

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