Use of iso‐osmolar contrast media during endovascular revascularization is associated with a lower incidence of major adverse renal, cardiac, or limb events

Abstract

Objective: We examined the association of iso-osmolar contrast media (IOCM) versus low-osmolar contrast media (LOCM) with major adverse renal, cardiovascular, or limb events in patients at high-risk of acute kidney injury (AKI) undergoing peripheral endovascular procedures.Background: Procedural characteristics including iodinated contrast type and volume have been associated with adverse renal and cardiovascular outcomes in patients undergoing angiographic interventions.Methods: Patients at high-risk of AKI, undergoing peripheral endovascular procedures were identified using the Premier Healthcare Database and separated into claudication and critical limb ischemia (CLI) cohorts. For each cohort, we compared IOCM versus LOCM for the primary endpoint of MARCE (major adverse renal or cardiovascular events) and secondary endpoints of major adverse renal events (MARE) and major adverse renal and limb events (MARLE). These outcomes were captured within the indexed hospitalization via adjusted multivariable regression analyses.Results: Two procedure-based cohorts of high-risk patients were formed: claudication (N = 11,976) and CLI (N = 8713). Use of IOCM was associated with a significant absolute risk reduction (ARR) of 2.2% (p < 0.0001) for MARCE overall and in each cohort (claudication, 1.8%, p = 0.0070; CLI, 2.7%, p = 0.0054). The incidence of MARE and MARLE in the overall cohort was also lower with the use of IOCM: MARE (ARR = 1.4%, p = 0.0072) and MARLE (ARR = 2.0%, p = 0.0043).Conclusions: Using IOCM versus LOCM in patients at high-risk of adverse renal events undergoing peripheral endovascular procedures was independently associated with lower risk of MARCE, MARE, and MARLE.

Treatment results of carotid artery stenting in a developing country

“…None of the patients received sodium bicarbonate or N-acetylcysteine, which have already been considered inefficient to prevent contrast-associated AKI 27 . Baseline creatinine levels were higher in patients with AKI; therefore, these had a greater risk for this outcome and could benefit from the use of low osmolarity contrast media 28 . However, we could not retrieve information about the type of contrast media used in these patients.…”

Key Considerations regarding the Renal Risks of Iodinated Contrast Media: The Nephrologist’s Role

“…The different studies considered those undergoing intra-arterial diagnostic or treatment procedures, those undergoing endovascular aneurysm repair (EVAR), and those undergoing peripheral vascular procedures. In each scenario, isoosmolar iodixanol was associated with a significant reduction in major adverse renal and cardiovascular events versus low-osmolar contrast media [41–43].…”

Iso‐osmolar versus low‐osmolar contrast agents to reduce the incidence of renal and cardiovascular side effects

“…In their recent report, “Use of iso‐osmolar contrast media during endovascular revascularization is associated with a lower incidence of major adverse renal, cardiac, or limb events,” Prasad et al 3 show that using IOCM versus low‐osmolar contrast media (LOCM) is associated with a significantly lower incidence of major adverse renal, cardiac, and limb events. Their study is one of the largest non–meta‐analytic studies (>20,000 patients spanning 7 years) to examine the short‐term effects of different contrast agents used for angiography, and it includes the novel endpoint of major adverse renal and limb events.…”