Hennessey Breda, Danenberg Haim, De Vroey Frédéric, Kirtane Ajay J, Parikh Manish, Karmpaliotis Dimitrios, Messenger John C, Strobel Aaron, Curcio Alejandro, van Mourik Martijn S, Eshuis Peter, Escaned Javier
Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain.
Department of Cardiology, Blackrock Clinic, Dublin, Ireland.
EuroIntervention. 2024 Feb 5;20(3):e198-e206. doi: 10.4244/EIJ-D-23-00460.
Decreasing the amount of iodinated contrast is an important safety aspect of percutaneous coronary interventions (PCI), particularly in patients with a high risk of contrast-induced acute kidney injury (CI-AKI). Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool projecting a motion-compensated virtual coronary roadmap overlay on fluoroscopy, potentially limiting the need for contrast during PCI.
This study investigates the contrast-sparing potential of DCR in PCI, compared to standard angiographic guidance.
The Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) trial is a multicentre, international, prospective, unblinded, stratified 1:1 randomised controlled trial. Patients were randomised to either DCR-guided PCI or to conventional angiography-guided PCI. The primary endpoint was the total volume of iodinated contrast administered, and the secondary endpoint was the number of cineangiography runs during PCI.
The study population included 356 randomised patients (179 in DCR and 177 in control groups, respectively). There were no differences in patient demographics, angiographic characteristics or estimated glomerular filtration rate (eGFR) between the two groups. The total contrast volume used during PCI was significantly lower with DCR guidance compared with conventional angiographic guidance (64.6±44.4 ml vs 90.8±55.4 ml, respectively; p<0.001). The total number of cineangiography runs was also significantly reduced in the DCR group (8.7±4.7 vs 11.7±7.6 in the control group; p<0.001).
Compared to conventional angiography-guided PCI, DCR guidance was associated with a significant reduction in both contrast volume and the number of cineangiography runs during PCI. (ClinicalTrials.gov: NCT04085614).
减少碘化造影剂用量是经皮冠状动脉介入治疗（PCI）的一个重要安全方面，特别是在有造影剂诱发急性肾损伤（CI-AKI）高风险的患者中。动态冠状动脉造影导航（DCR）是一种PCI导航支持工具，可在荧光透视下投射运动补偿虚拟冠状动脉造影导航图，有可能减少PCI期间对造影剂的需求。
本研究旨在探讨与标准血管造影引导相比，DCR在PCI中的造影剂节省潜力。
减少造影剂用量的动态冠状动脉造影导航（DCR4Contrast）试验是一项多中心、国际性、前瞻性、非盲、分层1:1随机对照试验。患者被随机分为DCR引导的PCI组或传统血管造影引导的PCI组。主要终点是碘化造影剂的总用量，次要终点是PCI期间电影血管造影的次数。
研究人群包括356例随机分组的患者（DCR组179例，对照组177例）。两组患者的人口统计学、血管造影特征或估计肾小球滤过率（eGFR）无差异。与传统血管造影引导相比，DCR引导下PCI期间使用的造影剂总量显著降低（分别为64.6±44.4 ml和90.8±55.4 ml；p<0.001）。DCR组电影血管造影的总次数也显著减少（对照组为8.7±4.7次，DCR组为11.7±7.6次；p<0.001）。
与传统血管造影引导的PCI相比，DCR引导与PCI期间造影剂用量和电影血管造影次数的显著减少相关。（ClinicalTrials.gov：NCT04085614）
