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| |  No Difference Found Between Iso-Osmolar and Low Iso-Osmolar Contrast Agents Among Renal Disease Patients: Presented at SCAI By Ed Susman CHICAGO -- April 7, 2008 -- Researchers said they could find no differences in outcomes among renal patients who underwent imaging studies with iso-osmolar contrast medium compared with low iso-osmolar contrast medium. "We were surprised by the findings of this study," said Rainer Wessely, MD, PhD, Associate Professor of Medicine, Deutsches Herzzentrum, Technische Universitaet, Munich, Germany. "We had expected that the low iso-osmolar agent would cause less contrast-induced nephrotoxicity, but that did not happen." In the Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty (CONTRAST) trial, researchers hoped to find a strategy that could lessen the threat of nephrotoxicity among patients with renal disease undergoing percutaneous coronary interventions that require contrast agents known to cause kidney problems. "Patients with chronic renal failure are at increased risk for contrast medium-induced nephroplasty that is associated with adverse outcomes," Dr. Wessely said on April 1 here at the Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI 2008), held in conjunction with the American Heart Association Innovation in Intervention: i2 Summit. "Patients with chronic renal insufficiency have a high need of coronary procedures; however, these procedures involve the use of contrast medium, which may lead to contrast-induced nephropathy or further kidney damage," he explained. Adult patients with chronic renal failure were eligible for the trial if they were scheduled for coronary angiography with the intention of having angioplasty. Chronic renal failure was defined as a glomerular filtration rate of 60 mL/min or less or a serum creatinine level of 1.5 mg/dL or more. The primary endpoint of the study was an increase in serum creatinine during hospitalisation for percutaneous coronary intervention. The researchers enrolled 975 patients into the study, of whom 477 were assigned to receive an iso-osmolar contrast medium and 498 were assigned to receive low iso-osmolar contrast medium. The analysis included the 162 patients in each group who actually had angioplasty performed. The patients who received the iso-osmolar contrast agent entered the study with an average serum creatinine level of 1.36 mg/dL, and following hospitalisation the level was 1.55 mg/dL, an increase of 0.19 mg/dL. The patients receiving the low iso-osmolar contrast medium entered the study with an average serum creatinine level of 1.37 mg/dL, and after intervention the level increased to 1.59 mg/dL, a difference of 0.22 mg/dL (P = .51). Rates of severe contrast-induced nephrotoxicity were not significantly different between groups, occurring in 6.2% of the iso-osmolar patients and 3.7% of patients in the low iso-osmolar contrast medium group (P = .30). Need for dialysis was low in both groups: 1.9% of patients receiving iso-osmolar contrast medium and 0.6% of low iso-osmolar patients (P = .31). Patients remained in hospital an average of 6.3 days if they received iso-osmolar contrast medium and 6.5 days if they received low iso-osmolar contrast medium (P = .59). Contrast-induced nephropathy occurred in 22.2% of patients on iso-osmolar contrast medium and in 27.7% of patients on low iso-osmolar contrast medium (P = .25). Outcomes were similar in the two groups. About 2.5% of patients in each group required target vessel revascularisation (P = 1.00); about 3.7% of patients getting iso-osmolar contrast medium experienced myocardial infarction, compared with 4.3% of patients receiving low iso-osmolar contrast medium (P = .77); and no stent thrombosis occurred in either group. About 1.2% of the iso-osmolar patients died, compared with 1.8% of the low iso-osmolar patients (P = .65); major adverse coronary events occurred in 6.2% of iso-osmolar patients, compared with 6.8% of low iso-osmolar patients (P = .85).
[Presentation title: Randomized Clinical Trial to Compare the Nephrotoxic Effects of Iso-Osmolar Versus Low-Osmolar Contrast Medium in Patients With Impaired Renal Function Undergoing Percutaneous Coronary Intervention: The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty (CONTRAST) Study. Abstract 2411-13]
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