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Outcomes similar with different low-osmolar iodinated contrast agents

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Among patients undergoing invasive coronary angiography or PCI with the use of low-osmolar contrast media (LOCM), adverse outcomes are uncommon with no advantage apparent between different agents.

That finding comes from a retrospective examination of data on over 100,000 patients, reported in the American Journal of Cardiology online March 22 by Dr. James K. Min, with Cedars-Sinai Medical Center in Los Angeles, California; and colleagues.

“In contrast to previous studies that compared LOCM to iso-osmolar contrast media, our study directly compared alternate LOCM for differences in clinical outcomes,” they point out.

They note that previous reports have suggested that iohexol may be associated with increased rates of contrast-induced nephropathy (CIN) compared to an iso-osmolar contrast medium, whereas this has not been reported with other LOCM such as ioversol and iopamidol.

To determine if there is any difference between LOCMs, the team looked at outcomes in patients exposed to iohexol (n = 20,136), iopamidol (n = 21,539) or ioversol (n = 66,319) during invasive coronary angiography (ICA) and/or PCI.

Propensity scoring generated 19, 482 matched pairs of patients exposed to iohexol versus ioversol, and 10,204 pairs exposed to iohexol vs iopamidol, the researcher report.

They found no significant difference between the iohexol-ioversol pairs in the rate of new inpatient hemodialysis (relative risk 0.72; p=0.05), inpatient mortality (RR 0.90; p=0.42), or rates of 30-day readmission for CIN (RR 0.81; p=0.52).

Outcomes were also similar between the matched iohexol-iopamidol patients in terms of inpatient hemodialysis (RR 1.18; p=0.45), inpatient mortality (RR 1.09; p=0.60), or 30-day CIN readmission (RR 1.11; p=0.82).

“Encouragingly, in this large dataset, even before matching, rates of in-hospital hemodialysis and mortality and 30-day readmission rates for CIN were low for all patients, irrespective of contrast medium used,” Dr. Min and colleagues comment.

“After matching,” they conclude, “we could not identify any significant differences in adverse events for patients who underwent ICA and/or PCI with different LOCM.”

SOURCE:

Within-Hospital and 30-Day Outcomes in 107,994 Patients Undergoing Invasive Coronary Angiography With Different Low-Osmolar Iodinated Contrast Media

Am J Cardiol 2012;