Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).

Abstract

Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ≥25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ≥50%, increase in sCr ≥0.5 or ≥1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention, iopromide was not inferior to iodixanol in the occurrence of CI-AKI; no significant differences were found in terms of tissue-level reperfusion and major adverse cardiac events between the 2 contrast agents.

• Authors: Leonardo Bolognese, Giovanni Falsini, Carsten Schwenke, Simone Grotti, Ugo Limbruno, Francesco Liistro, Arcangelo Carrera, Paolo Angioli, Andrea Picchi, Kenneth Ducci, Carlo Pierli
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 109 Issue 1 Pg. 67-74 (Jan 01 2012) ISSN: 1879-1913 [Electronic] United States
• PMID: 21943940 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Contrast Media
• Triiodobenzoic Acids
• Iohexol
• iopromide
• iodixanol

Topics

• Acute Kidney Injury (chemically induced, epidemiology, physiopathology)
• Aged
• Angioplasty, Balloon, Coronary (methods)
• Contrast Media (adverse effects)
• Coronary Angiography (adverse effects, methods)
• Coronary Circulation (drug effects)
• Electrocardiography
• Female
• Follow-Up Studies
• Glomerular Filtration Rate (drug effects)
• Humans
• Incidence
• Iohexol (adverse effects, analogs & derivatives)
• Italy (epidemiology)
• Male
• Myocardial Infarction (diagnostic imaging, physiopathology, therapy)
• Myocardial Reperfusion Injury (chemically induced, epidemiology, physiopathology)
• Prognosis
• Prospective Studies
• Risk Factors
• Single-Blind Method
• Triiodobenzoic Acids (adverse effects)