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Contemporary use of and outcomes associated with ultra‐low contrast volume in patients undergoing percutaneous coronary interventions
Author(s) -
Gurm Hitinder S.,
Seth Milan,
Dixon Simon R.,
Michael Grossman P.,
Sukul Devraj,
Lalonde Thomas,
Can Louis,
West Daniel,
Madder Ryan D.,
Adam Lauver D.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27819
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , dialysis , contrast (vision) , incidence (geometry) , cardiology , acute kidney injury , creatinine , hemodialysis , myocardial infarction , physics , artificial intelligence , computer science , optics
Background The risk of contrast‐induced acute kidney injury (CI‐AKI) increases in a nonlinear fashion with increasing volume of contrast media. Prior studies recommend limiting contrast volume to less than three times the estimated creatinine clearance (CC). Recently, a number of operators have reported successful percutaneous coronary intervention (PCI) using even lower volumes of contrast. Objectives To evaluate the prevalence and outcomes associated with ultra‐low contrast volume among patients undergoing PCI. Methods We assessed the prevalence and outcomes associated with use of ultra‐low contrast volume among 75 393 patients undergoing PCI in Michigan between July 2014 and June 2017 in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry. Ultra‐low contrast volume was defined as contrast volume less than or equal to the patient's estimated CC. Patients receiving dialysis at the time of the procedure were excluded. Results Ultra‐low contrast volume was used in 13% of procedures with the majority of these patients being at low risk of renal complications. Compared with patients who received a contrast volume between one and three times the CC, use of ultra‐low volume of contrast was associated with a significantly lower incidence of AKI (aOR 0.682, 95% CI 0.566–0.821, P < 0.001) and a lower incidence of need for dialysis (aOR = 0.341, 95% CI 0.165–0.704, P = 0.003). These benefits were most evident in the patients with a high baseline predicted risk of AKI. Conclusions A small but clinically significant number of patients are treated with ultra‐low contrast volume. Ultra‐low contrast volume use is associated with a significant reduction in the incidence of AKI or need for dialysis. It may be prudent to consider this new threshold when performing PCI on patients who are at an increased risk of AKI.