Prasad Anand, Amin Amit P, Ryan Michael P, Gunnarsson Candace, Brilakis Emmanouil S
Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA.
Division of Cardiology, Geisel School of Medicine, Dartmouth, USA.
Catheter Cardiovasc Interv. 2022 Mar;99(4):1335-1342. doi: 10.1002/ccd.30006. Epub 2021 Nov 12.
We examined the association of iso-osmolar contrast media (IOCM) versus low-osmolar contrast media (LOCM) with major adverse renal, cardiovascular, or limb events in patients at high-risk of acute kidney injury (AKI) undergoing peripheral endovascular procedures.
Procedural characteristics including iodinated contrast type and volume have been associated with adverse renal and cardiovascular outcomes in patients undergoing angiographic interventions.
Patients at high-risk of AKI, undergoing peripheral endovascular procedures were identified using the Premier Healthcare Database and separated into claudication and critical limb ischemia (CLI) cohorts. For each cohort, we compared IOCM versus LOCM for the primary endpoint of MARCE (major adverse renal or cardiovascular events) and secondary endpoints of major adverse renal events (MARE) and major adverse renal and limb events (MARLE). These outcomes were captured within the indexed hospitalization via adjusted multivariable regression analyses.
Two procedure-based cohorts of high-risk patients were formed: claudication (N = 11,976) and CLI (N = 8713). Use of IOCM was associated with a significant absolute risk reduction (ARR) of 2.2% (p < 0.0001) for MARCE overall and in each cohort (claudication, 1.8%, p = 0.0070; CLI, 2.7%, p = 0.0054). The incidence of MARE and MARLE in the overall cohort was also lower with the use of IOCM: MARE (ARR = 1.4%, p = 0.0072) and MARLE (ARR = 2.0%, p = 0.0043).
Using IOCM versus LOCM in patients at high-risk of adverse renal events undergoing peripheral endovascular procedures was independently associated with lower risk of MARCE, MARE, and MARLE.
我们研究了等渗造影剂（IOCM）与低渗造影剂（LOCM）在接受外周血管内介入手术的急性肾损伤（AKI）高危患者中与主要不良肾脏、心血管或肢体事件的相关性。
包括碘化造影剂类型和用量在内的手术特征与接受血管造影介入治疗的患者的不良肾脏和心血管结局相关。
利用Premier医疗数据库识别出接受外周血管内介入手术的AKI高危患者，并将其分为跛行和严重肢体缺血（CLI）队列。对于每个队列，我们比较了IOCM与LOCM在主要不良肾脏或心血管事件（MARCE）的主要终点以及主要不良肾脏事件（MARE）和主要不良肾脏和肢体事件（MARLE）的次要终点方面的情况。通过调整后的多变量回归分析在索引住院期间获取这些结局。
形成了两个基于手术的高危患者队列：跛行（N = 11976）和CLI（N = 8713）。总体而言以及在每个队列中（跛行，1.8%，p = 0.0070；CLI，2.7%，p = 0.0054），使用IOCM与MARCE的显著绝对风险降低（ARR）2.2%相关（p < 0.0001）。使用IOCM时，总体队列中MARE和MARLE的发生率也较低：MARE（ARR = 1.4%，p = 0.0072）和MARLE（ARR = 2.0%，p = 0.0043）。
在接受外周血管内介入手术的不良肾脏事件高危患者中，使用IOCM而非LOCM与较低的MARCE、MARE和MARLE风险独立相关。
