Similar nephrotoxic effects with iodixanol and iomeprol in the CONTRAST trial

April 1, 2008 By Vijayalakshmi Kunadian MBBS MD MRCP [mailto:vkunadian@perfuse.org]

SCAI-ACCi2 08-Chicago, IL: The CONTRAST trial demonstrates that the nephrotoxic effects are similar with the iso-osmolar contrast media (iodixanol 320) versus low-osmolar contrast media (iomeprol 350) in patients with impaired renal function undergoing percutaneous coronary intervention. Dr. Rainer Wessely presented the results at the SCAI-i2 summit Annual Scientific Sessions in Chicago today.

Worsening of renal failure following the administration of contrast media during coronary angiography and percutaneous coronary intervention (PCI) is a major concern particularly among those with impaired renal function who tend to have diffuse, complex, multivessel coronary artery disease. The investigators in the CONTRAST (Contrast media and NephroToxicity Following Coronary Revascularization by AngioplaSTy study) study determined if the type of contrast media used would reduce the incidence of nephrotoxicity post PCI.

They recruited 975 patients who were randomized to undergo contrast injections with either iodixanol 320 (n=477) or iomeprol 350 (n=498). Patients with impaired renal function (serum creatinine >1.5 mg/dl or eGFR <60 ml/min) aged ≥ 18 years undergoing coronary angiography with an intention to have PCI were included in the study. Patients who had prior hemodialysis, in cardiogenic shock, who had prior renal transplantation, on nephrotoxic drugs and patients who received contrast media in the last seven days were excluded from the study. All patients received intravenous hydration prior to the procedure.

In either group 162 patients underwent PCI and were included in the analysis. There was no significant difference in the pre-PCI baseline characteristics between the two groups including serum creatinine (mg/ml), serum urea (mg/ml) and eGFR levels (ml/min/1.73m2). Following PCI, there was no difference in either the maximum serum creatinine (1.55 ± 0.58 vs. 1.59 ± 0.48, p=0.51), serum urea (59.4 ± 30.8 vs. 61.2 ± 30, p=0.59) or the maximum rise in serum creatinine levels (0.19 vs. 0.21, p=0.53) between the iodixanol group and the iomeprol groups respectively.

There was no significant difference in terms of reduction in contrast induced nephropathy [∆ serum creatinine >25%: 22.2% vs. 27.7%, p=0.25 and hemodialysis: 1.9% vs. 0.6%, p=0.31] between the iodixanol and iomeprol groups. There was also no significant difference in terms of target vessel revascularization (2.5% vs. 2.5%, p=1), myocardial infarction (3.7% vs. 4.3%, p=0.77), death (1.2% vs. 1.8%, p=0.65) and major adverse cardiac events (6.2% vs. 6.8%, p=0.82) between the iodixanol and iomeprol groups respectively at 90 days. There was also no difference in the length of hospital stay between the two groups (6.3 days vs. 6.5 days, p=0.59).

This study concluded that there was no difference in the nephrotoxic effects of iso-osmolar and low-osmolar contrast media among patients with impaired renal function undergoing percutaneous coronary intervention.

Source
Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, April 1, 2008 Chicago