Juergens Craig P, Khaing Aye Mi, McIntyre Geraldine J, Leung Dominic Y C, Lo Sidney T H, Fernandes Clyne, Hopkins Andrew P
Department of Cardiology, Liverpool Hospital, Locked Bag 7103, Elizabeth Street, Liverpool, NSW 2170 Australia.
Heart Lung Circ. 2005 Sep;14(3):172-7. doi: 10.1016/j.hlc.2005.06.013. Epub 2005 Aug 25.
Due to perceived advantages in the use of non-ionic contrast agents for diagnostic angiography and ionic agents for percutaneous coronary intervention (PCI), patients often receive various combinations of both types of agents.
To assess potential adverse effects of non-ionic and ionic contrast media when used together or separately during percutaneous coronary intervention.
We retrospectively evaluated the outcomes of 532 patients undergoing percutaneous coronary intervention in our institution. Patients were divided into two groups: those that underwent diagnostic angiography and "follow on" PCI; and those that underwent "planned" PCI. The groups were subdivided on the basis of the use of the ionic agent ioxaglate or the non-ionic agent iopromide during PCI. The frequency of allergic reactions and major adverse cardiac events (MACE) were noted.
With respect to the "follow on" group, allergic reactions occurred in 9 of 150 patients (6.0%) who received the combination of ioxaglate and iopromide versus 1 of 93 (1.1%) who only received iopromide (p=0.094). There was no difference with respect to MACE [6 (4.0%) ioxaglate and iopromide versus 4 (4.3%) iopromide alone, p=1.00]. In the "planned" group, 7 of 165 patients (4.2%) receiving ioxaglate had an allergic reaction as opposed 0.0% (0 of 124 patients) in the iopromide group (p=0.021). All contrast reactions were mild. The incidence of a MACE was similar in both groups [1 (0.6%) ioxaglate versus 2 (1.6%) iopromide, p=0.579]. The incidence of allergic reactions was similar if ioxaglate was used alone or in combination with iopromide (p=0.478).
Whilst combining ionic and non-ionic contrast agents in the same procedure was not associated with any more adverse reactions than using an ionic contrast agent alone, the ionic contrast agent ioxaglate was associated with the majority of allergic reactions. With respect to choice of contrast agent, using the non-ionic agent iopromide alone for coronary intervention is associated with the lowest risk of an adverse event.
由于人们认为在诊断性血管造影中使用非离子型造影剂以及在经皮冠状动脉介入治疗（PCI）中使用离子型造影剂具有优势，患者常常会同时接受这两种造影剂的不同组合。
评估在经皮冠状动脉介入治疗期间，非离子型和离子型造影剂单独使用或联合使用时的潜在不良反应。
我们回顾性评估了在我院接受经皮冠状动脉介入治疗的532例患者的治疗结果。患者被分为两组：接受诊断性血管造影及“后续”PCI的患者；以及接受“计划性”PCI的患者。根据PCI期间使用离子型造影剂碘克沙醇或非离子型造影剂碘普罗胺对两组进行细分。记录过敏反应和主要不良心脏事件（MACE）的发生频率。
在“后续”组中，150例接受碘克沙醇和碘普罗胺联合使用的患者中有9例（6.0%）发生过敏反应，而仅接受碘普罗胺的93例患者中有1例（1.1%）发生过敏反应（p = 0.094）。MACE方面无差异[碘克沙醇和碘普罗胺联合使用组为6例（4.0%），单独使用碘普罗胺组为4例（4.3%），p = 1.00]。在“计划性”组中，165例接受碘克沙醇的患者中有7例（4.2%）发生过敏反应，而碘普罗胺组为0.0%（124例患者中0例）（p = 0.021）。所有造影剂反应均为轻度。两组MACE发生率相似[碘克沙醇组为1例（0.6%），碘普罗胺组为2例（1.6%），p = 0.579]。单独使用碘克沙醇或与碘普罗胺联合使用时过敏反应发生率相似（p = 0.478）。
虽然在同一手术中联合使用离子型和非离子型造影剂与单独使用离子型造影剂相比，并未增加不良反应，但离子型造影剂碘克沙醇与大多数过敏反应相关。就造影剂的选择而言，单独使用非离子型造影剂碘普罗胺进行冠状动脉介入治疗时不良事件风险最低。
