Le Feuvre Claude, Batisse Anne, Collet Jean P, Batisse Jean P, Choussat Rémy, Beygui Farzin, Helft Gérard, Montalescot Gilles, Metzger Jean P
Cardiology Department, Pitié-Salpêtrière Hospital, 47 et 83 Bd de l'Hôpital, 75651 Paris cedex 13, France.
Catheter Cardiovasc Interv. 2006 Jun;67(6):852-8. doi: 10.1002/ccd.20670.
Our study aimed to compare the isosmolar nonionic dimer iodixanol and the low osmolar ionic agent ioxaglate in the current era of percutaneous coronary intervention (PCI), using clopidogrel, enoxaparine, direct stenting, and drug eluting stent.
Previous studies have suggested an association between thrombus-related events and type of contrast media.
Our prospective single-center study included 498 consecutive patients who were assigned to receive either iodixanol (n = 231) or ioxaglate (n = 267). The primary endpoint was the cumulative rate of in-hospital major adverse clinical events (MACE). A secondary endpoint was the rate of angiographic or procedural complications.
Clinical and angiographic baseline characteristics and procedural data were similar in the 2 groups. A peak anti-Xa > 0.5 IU/ml was obtained in 97% in both groups. Glycoprotein IIb/IIIa inhibitors were used in 42% of patients. Coronary stenting was performed in 91% of patients, with direct stenting in 70%, and drug-eluting stent in 28% of patients. In-hospital MACE was more frequent in patients receiving iodixanol compared with those receiving ioxaglate (4.8% vs. 0.3%, P < 0.005). This difference was mainly related to the appearance of a large thrombus during PCI (6% with iodixanol vs. 0.3% with ioxaglate, P < 0.0001). In multivariate analysis, independent predictors of in-hospital MACE were use of iodixanol (P < 0.01), the higher number of stent used (P < 0.008), bifurcation/ostial lesion (P < 0.01), and balloon dilation before stenting (p < 0.001).
In our study reflecting the current era of PCI, thrombus-related events are more frequent with the isosmolar nonionic dimer iodixanol than with the low osmolar ionic agent ioxaglate.
我们的研究旨在，在当前经皮冠状动脉介入治疗（PCI）时代，使用氯吡格雷、依诺肝素、直接支架置入术和药物洗脱支架，比较等渗非离子二聚体碘克沙醇和低渗离子型造影剂碘克酸。
既往研究提示血栓相关事件与造影剂类型之间存在关联。
我们的前瞻性单中心研究纳入了498例连续患者，这些患者被分配接受碘克沙醇（n = 231）或碘克酸（n = 267）。主要终点是院内主要不良临床事件（MACE）的累积发生率。次要终点是血管造影或手术并发症的发生率。
两组的临床和血管造影基线特征及手术数据相似。两组中97%的患者抗Xa峰值> 0.5 IU/ml。42%的患者使用了糖蛋白IIb/IIIa抑制剂。91%的患者进行了冠状动脉支架置入术，其中70%为直接支架置入术，28%的患者使用了药物洗脱支架。与接受碘克酸的患者相比，接受碘克沙醇的患者院内MACE更常见（4.8%对0.3%，P < 0.005）。这种差异主要与PCI期间出现大血栓有关（碘克沙醇组为6%，碘克酸组为0.3%，P < 0.0001）。在多变量分析中，院内MACE的独立预测因素是使用碘克沙醇（P < 0.01）、使用的支架数量较多（P < 0.008）、分叉/开口病变（P < 0.01）以及支架置入前的球囊扩张（P < 0.001）。
在我们反映当前PCI时代的研究中，与低渗离子型造影剂碘克酸相比，等渗非离子二聚体碘克沙醇导致的血栓相关事件更频繁。
