Cath Lab Digest - January 2008 - (Page 9)

9 doesn’t exist. Iodixanol (Visipaque) may not be superior for the prevention of contrast nephropathy. That’s an important statement. The trial results do not claim superiority for any one agent. The CARE trial shows only that low-osmolar agents are not worse and that there is probably no clinical significance between the two types in the prevention of contrastinduced nephropathy, given the small sample size of the CARE trial. In your own practice, how have the recent CARE trial results and other data affected your decisions about contrast media? I am now convinced that the lowosmolar compounds may be just as effective as iso-osmolar compounds in prevention of CIN. Can you talk more about the dangers of high contrast volumes? I think the volume of contrast media is one of the most important considerations in avoiding CIN, maybe even more important than the type of contrast media utilized. Ask yourself: Did we hydrate the patient? Did we assess their risk? Did we take all of the integers in Figure 1 into consideration? Look at the patient as a whole and then do everything you possibly can to protect them from CIN by hydrating, assessing risk, not giving too much contrast volume and so on. In every presentation I make, I stress these points. What are some of the typical concerns brought up when you speak about this issue? There are a lot of people who truly believe that the iso-osmolar compound is superior to the low-osmolar. There are a lot of people who believe that N-acetylcysteine works. There are many who believe that bicarbonate hydration works. Finally, there are those of us who believe that none of these things make that much of a difference. It’s great that we have all of these data, but the most effective thing we can do is go back to the basics and look at the patient, assess their risk, hydrate them when we can and use as little contrast media as possible. What have you found to be an effective method to reduce contrast volume use? We have made a big impact simply by having people recognize CIN as an important complication and also hydrating the patients. The rates of contrast nephropathy have decreased tremendously in our own institution. We are now at about 7%, and we used to be at 16%. The one thing we have done is to pay a lot of attention to patient risk and hydration. We bring high-risk patients in the night before, keep them an extra day post procedure to make sure they are well-hydrated and watch their creatinine levels. What needs to be done to answer some of the remaining questions about contrast media and CIN? I would like to see a larger trial. Unfortunately, no one is going after the large trials. Of all of the trials we are seeing, the biggest problem is that they are quite small. Larger trials with real answers would be great. ■ Dr. Roxana Mehran can be contacted at rmehran@crf.org Reference 1. Marenzi G, Assannelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 2006 Jun 29;354(26):2773-2782. Recommended Reading 1. 2. 3. 4. 5. 6. Davidson CJ, Laskey WK, Hermiller JB, et al. Randomized trial of contrast media utilization in high-risk PTCA: The COURT trial. Circulation 2000;101:2172–2177. Mehran R. Contrast-induced nephropathy remains a serious complication of PCI. J Interv Cardiol 2007 Jun;20(3):236-240. Mehran R, Aymong ED, Nikolsky E. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004 Oct;44(7):1393-1399. Nikolsky E, Pucelikova T, Mehran R. An evaluation of fluoroscopy time and correlation with outcomes after percutaneous coronary intervention. J Invasive Cardiol 2007 May;19(5):208-13. Pucelikova T, Dangas G, Mehran R. Contrastinduced nephropathy. Catheter Cardiovasc Interv 2007 Nov 1; [Epub ahead of print on www.pubmed.com]. Solomon RJ, Natarajan MK, Doucet S, et al, and the Investigators of the CARE Study Cardiac Angiography in Renally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease. Circulation June 26, 2007;115(25):3189–3196. http://www.pubmed.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - January 2008

Cath Lab Digest - January 2008 Central Baptist Hospital Contrast Media Use in High-Risk Patients An Ergonomic Survey of Cath Lab Repetitive Stress Injuries Contents Clinical Editor’s Corner Takotsubo Cardiomyopathy, a.k.a., Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter Searching for the Key to D2B STEMI Intervention News STEMI Interventions: Commentary The Massachusetts Stent Study The Value of Educating Staff Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab SICP* Chapter Updates The Society of Invasive Cardiovascular Professionals Holds an RCIS Review Course at New Cardiovascular Horizons 18:20 To Denver — One Student’s First Clinical Experience CEU Education Center Meetings Calendar What Do You Think? Clinical & Industry News Classifieds The Ten-Minute Interview with…Heather Vardon, RN Advertisers Index

Cath Lab Digest - January 2008

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