Extended Renal Outcomes with Use of Iodixanol versus Iohexol after Coronary Angiography

الملخص EN

The impact of isoosmolar versus low-osmolar contrast media (CM) administration on contrast-induced acute kidney injury (CI-AKI) and extended renal dysfunction (ERD) is unclear.

We retrospectively examined incidences of CI-AKI and ERD in patients who received iodixanol (isoosmolar) versus iohexol (low-osmolar) during angiography for cardiac indications.

Of 713 patients, 560 (cohort A), 190 (cohort B), and 172 (cohort C) had serum creatinine monitored at 3 days, 30 days, and 6 months after angiography, respectively.

18% of cohort A developed CI-AKI, which was more common with iodixanol than iohexol (22% versus 13%, P=0.006).

However, patients given iodixanol were older with lower baseline estimated glomerular filtration rates (eGFR).

On multivariate analysis, independent associations with higher CI-AKI risk include age >65 years, female gender, cardiac failure, ST-elevation myocardial infarction, intra-aortic balloon pump, and critical illness, but not CM type, higher CM load, or eGFR<45 mL/min/1.73 m2.

32% of cohort B and 34% of cohort C had ERD at 30 days and 6 months, while 44% and 41% of subcohorts had ERD at 90 days and 1 year, respectively.

CI-AKI, but not CM type, was associated with medium- and longer-term ERD, with 3-fold higher risk.

Advanced age, emergent cardiac conditions, and critical illness are stronger predictors of CI-AKI, compared with CM-related factors.

CI-AKI predicts longer-term ERD.