Mukai Yasuhiro, Sakakura Kenichi, Yamamoto Kei, Taniguchi Yousuke, Tsukui Takunori, Seguchi Masaru, Wada Hiroshi, Momomura Shin-Ichi, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
Heart Vessels. 2020 Feb;35(2):143-152. doi: 10.1007/s00380-019-01473-3. Epub 2019 Jul 20.
Since the amount of contrast media during percutaneous coronary intervention (PCI) is closely related to the exacerbation of renal function, it should be important to reduce the dose of contrast media during PCI. The purpose of this retrospective study was to evaluate the association of less-contrast media with clinical factors in elective PCI. A total of 709 patients were divided into the less-contrast media group (n = 142) and the conventional-contrast media group (n = 567) according to the quintile of total contrast volume. Univariate and multivariate logistic regression analyses were performed to find associations between the clinical variables and the less-contrast media group. The intravascular ultrasound (IVUS) use rate in the study population was considerably high (94.9%). In multivariable logistic regression analysis, an eGFR < 30 mL/min/1.73 m without hemodialysis was significantly associated with the less-contrast media group [odds ratio (OR) 43.73, 95% confidence interval (CI) 14.05-136.09, P < 0.001]. Left main-left anterior descending artery lesion (OR 0.28, 95% CI 0.17-0.48, P < 0.001), bifurcation lesion (OR 0.39, 95% CI 0.16-0.92, P = 0.03), chronic total occlusion (OR 0.22, 95% CI 0.06-0.90, P = 0.03) were inversely associated with the less-contrast media group. In conclusion, complex lesion characteristics were inversely associated with the less-contrast media in elective PCI. Since operators could access patients' renal function before elective procedure, an eGFR < 30 mL/min/1.73 m was most significantly associated with the less-contrast media. Our results suggest the possibility that the amount of contrast media is controllable in current PCI under IVUS-guidance.
由于经皮冠状动脉介入治疗（PCI）期间造影剂的用量与肾功能恶化密切相关，因此在PCI期间减少造影剂剂量非常重要。这项回顾性研究的目的是评估选择性PCI中较少造影剂用量与临床因素之间的关联。根据总造影剂用量的五分位数，将709例患者分为较少造影剂用量组（n = 142）和传统造影剂用量组（n = 567）。进行单因素和多因素逻辑回归分析，以找出临床变量与较少造影剂用量组之间的关联。研究人群中血管内超声（IVUS）的使用率相当高（94.9%）。在多因素逻辑回归分析中，估算肾小球滤过率（eGFR）<30 mL/min/1.73 m²且未进行血液透析与较少造影剂用量组显著相关[比值比（OR）43.73，95%置信区间（CI）14.05 - 136.09，P < 0.001]。左主干 - 左前降支病变（OR 0.28，95% CI 0.17 - 0.48，P < 0.001）、分叉病变（OR 0.39，95% CI 0.16 - 0.92，P = 0.03）、慢性完全闭塞（OR 0.22，95% CI 0.06 - 0.90，P = 0.03）与较少造影剂用量组呈负相关。总之，在选择性PCI中，复杂病变特征与较少造影剂用量呈负相关。由于术者在择期手术前可以了解患者的肾功能，eGFR < 30 mL/min/1.73 m²与较少造影剂用量的相关性最为显著。我们的结果表明，在当前IVUS引导下的PCI中，造影剂用量是可控的。
