Impact of Automated Contrast Injector Systems on Contrast Use and Contrast-Associated Complications in Patients Undergoing Percutaneous Coronary Interventions

Autor: Srinivas Koneru, Hitinder S. Gurm, Dean G. Smith, Dan Menees, John Collins, Stanley Chetcuti, David Share, Mohan Madala, David Wohns
Rok vydání: 2013
Předmět:
Male
Michigan
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
education
Contrast Media
Radiography
Interventional
automated contrast injector system (ACIS)
Injections
Automation
Drug Delivery Systems
Percutaneous Coronary Intervention
Renal Dialysis
Risk Factors
Odds Ratio
medicine
Humans
Risk factor
Propensity Score
Aged
Aged
80 and over
Chi-Square Distribution
biology
business.industry
Percutaneous coronary intervention
Odds ratio
Middle Aged
biology.organism_classification
Acis
Logistic Models
Treatment Outcome
Creatinine
Multivariate Analysis
Conventional PCI
Propensity score matching
contrast-induced nephropathy (CIN)
Female
Kidney Diseases
Radiology
percutaneous coronary intervention (PCI)
Cardiology and Cardiovascular Medicine
business
Chi-squared distribution
Biomarkers
Zdroj: JACC: Cardiovascular Interventions. 6:399-405
ISSN: 1936-8798
Popis: ObjectivesThe purpose of this study was to assess the impact of manual versus automated contrast injection on renal complications in patients undergoing percutaneous coronary intervention (PCI).BackgroundContrast volume is a major modifiable risk factor for contrast-induced nephropathy (CIN). Automated contrast injector systems (ACIS) are believed to be associated with a reduction in the total volume of contrast media use.MethodsWe compared the outcome of 60,884 patients who underwent PCI at 28 hospitals in Michigan in 2008 to 2009 and assessed the outcome of those treated at hospitals that did not use ACIS (n = 24) and compared them with those that used ACIS (n = 4). Propensity matching was used to adjust for baseline differences.ResultsThe use of ACIS was associated with a statistically significant albeit clinically small difference in the average volume of contrast media use (mean 199 ± 84 ml vs. mean 204 ± 82 ml, p < 0.0001) with no difference in proportion of patients exceeding contrast volume/calculated creatinine clearance ratio of 3 (28.4% vs. 29.1%, p = 0.19). There was no difference in the incidence of CIN (3.11% vs. 3.42%, p = 0.15) or new need for dialysis (0.30% vs. 0.33%, p = 0.54), and these differences remained nonsignificant in propensity matched analysis. In fully adjusted, multivariate logistic analysis, patients treated with ACIS remained as likely to develop CIN (odds ratio: 0.96, 95% confidence interval: 0.83 to 1.11, p = 0.56) or new need for dialysis (odds ratio: 0.83, 95% confidence interval: 0.54 to 1.28, p = 0.40).ConclusionsCompared with hospitals using manual injection, institutions having ACIS used slightly less amount of contrast with no reduction in CIN. Use of ACIS is unlikely to impact contrast-induced renal complications in patients undergoing PCI.
Databáze: OpenAIRE
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