Premium
Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions
Author(s) -
Amr Bashar S.,
Lippmann Matthew,
Tobbia Patrick,
Isom Nicholas,
Dalia Tarun,
Buechler Tyler,
Pierpoline Michael,
Patel Nilay,
Hockstad Eric,
Wiley Mark,
Tadros Peter,
Mehta Ashwani,
Earnest Matthew,
Chen John G.,
Gupta Kamal
Publication year - 2020
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.28618
Subject(s) - medicine , mace , blood pressure , clinical endpoint , incidence (geometry) , angiography , adverse effect , cardiology , diabetes mellitus , surgery , percutaneous coronary intervention , myocardial infarction , randomized controlled trial , endocrinology , physics , optics
Objectives Oral steroids are routinely administered in the United States for prophylaxis of iodinated contrast media hypersensitivity (ICMH). We studied the impact of short‐term steroid use in diabetic patients with ICMH undergoing nonemergent coronary angiography. Methods We retrospectively analyzed records of diabetic patients with and without ICMH who underwent nonemergent coronary angiography at our center. Primary study endpoint was 30‐day major adverse cardiac events (MACE) and secondary endpoints were pre‐ and postprocedure fasting blood glucose (FBG), highest in hospital blood glucose, pre‐ and postprocedure systolic blood pressure (SBP), and use of intravenous insulin and antihypertensive medications. Results A total of 88 diabetics with ICMH (study group) and 76 diabetics without ICMH (control group) undergoing angiography were enrolled. Demographics and hemoglobin A1c values were similar in both groups. Preprocedural FBG was significantly higher in the study group. The study group had significantly higher post angiography FBG (239.93 + 96.88 mg/dl vs. 156.6 + 59.88 mg/dl) and greater use of intravenous (IV) insulin (67.27% vs. 32.43%). Further, those who received steroids had significantly higher systolic SBP postprocedure (146.16 + 25.35 mmHg vs. 130.8 + 21.59 mmHg), a higher incidence of severe hypertension and use of IV antihypertensive medications (80.95% vs. 19.05%) periprocedurally. There were no differences in 30‐day MACE between groups. Conclusion Short‐term steroid use for ICMH results in a significant increase in surrogate markers for adverse clinical events after coronary procedures. Study findings highlight the need for better periprocedural management of these patients and to limit steroid prophylaxis to those with only true ICMH.