Contrast Media Selection in Interventional Cardiology
Journal of Clinical and Basic Cardiology 2001; 4 (4): 245-248
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Keywords: ionisch, Kontrastmittel, Nebenwirkung, nichtionisch, PTCA, contrast medium, ionic, non-ionic, PTCA, side effects
This paper reviews the main articles published in the literature comparing radio contrast agents in terms of thrombus formation during percutaneous transluminal coronary angioplasty (PTCA), general tolerability, as well as iodine concentration, viscosity and delivery rate, which are important in view of the progressive narrowing of PTCA-guiding catheters. The review included 10 randomised, controlled trials comparing contrast media in coronary angioplasty, as well as two meta-analyses, another 3 large trials and safety data received by the FDA. Contrast Media and Clotting: In the 10 randomised studies no significant differences were observed in the incidence of emergent bypass surgery (non-ionic vs. ionic, 1.3 % vs. 1.1 %), myocardial infarction (3.0 % vs. 3.1 %), and cardiac death (0.4 % vs. 0.4 %) in a total of 6249 patients. General tolerability: According to reports to the FDA the incidence of lethal complications per million examinations was 3.90 (ionic monomers), 6.39 (ioxaglate), and 2.07 (non-ionic monomers). There are some reports on delayed reactions after the use of non-ionic dimers. Iodine Delivery Rate: The iodine delivery rate is a function not only of catheter diameter and length, but also of contrast medium iodine content and viscosity (and temperature) The importance of using contrast media with a high iodine concentration (400 mg/ml) has been shown both in vitro and in vivo. In conclusion, non-ionic contrast media do not have any "thrombogenic potential". There is no correlation between major adverse cardiac events after PTCA and the type of contrast medium. Non-ionic contrast media reduce the risk of adverse drug reaction in patients undergoing both diagnostic cardiac catheterization and catheter-based coronary interventions. There are also significant differences between dimeric and monomeric non-ionic compounds. Non-ionic monomers have a higher iodine content/viscosity ratio than non-ionic dimers. As the iodine delivery rate depends on the iodine concentration and viscosity of the contrast medium, the contrast medium with the highest iodine content/viscosity ratio can ensure the best opacification.