Journal of the American College of Cardiology
A randomized trial of low osmolar ionic versus nonionic contrast media in patients with myocardial infarction or unstable angina undergoing percutaneous transluminal coronary angioplasty
Author + information
- Cindy L. Grines, MD,FACC∗,
- Theodore L. Schreiber, MD,FACC,
- Vicky Savas, MD,
- Denise E. Jones, RN,
- Frank J. Zidar,
- Vellappillil Gangadharan, MD,FACC,
- Marc Brodsky, MD,FACC,
- Robert Levin, MD,FACC,
- Robert Safian, MD,FACC,
- Sylvia Puchrowicz-Ochocki, MD,
- Mark D. Castellani, MD and
- William W. O'Neill, MD,FACC
- ↵∗Address for correspondence: Cindy L. Grines, MD, FACC, William Beaumont Hospital, Division of Cardiology, 3601 West Thirteen Mile Road, Royal Oak, Michigan 48073-6769.
Abstract
Objectives. The purpose of this study was to determine prospectively whether the differences in anticoagulant and antiplatelet effects of ionic and nonionic contrast media alter angiographic or clinical outcomes in patients with unstable ischemic syndromes undergoing percutaneous transluminal coronary angioplasty.
Background. The interaction of platelets and thrombin with the endothelium of injured vessels contributes to thrombosis and restenosis after coronary angioplasty. Case reports and retrospective observations have reported an increased risk of thrombosis with the use of nonionic contrast media.
Methods. A total of 211 patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty were randomized to receive nonionic or ionic low osmolar contrast media. Coronary angiograms were assessed by a technician blinded to the study contrast media, and clinical events were monitored by an independent nurse for 1 month.
Results. Patients receiving the ionic media were significantly less likely to experience decreased blood flow during the procedure (8.1% vs. 17.8%, p = 0.04). After the angioplasty, residual stenosis, vessel patency, the incidence of moderate to large thrombi and use of adjunctive thrombolytic therapy were similar between the two groups. However, patients receiving ionic media had fewer recurrent ischemic events requiring repeat catheterization (3.0% vs. 11.4%, p = 0.02) and repeat angioplasty during the initial hospital stay (1.0% vs. 5.8%, p = 0.06). One month after angioplasty, patients receiving ionic contrast media reported significantly fewer symptoms of any angina (8.5 vs. 20.0%, p = 0.04) or of angina at rest (1.4% vs. 11.8%, p = 0.01) and a reduced need for subsequent bypass surgery (0% vs. 5.9%, p = 0.04), compared with patients receiving the nonionic media.
Conclusions. These findings demonstrate that in patients with unstable ischemic syndromes undergoing coronary angioplasty, the use of ionic low osmolar contrast media reduces the risk of ischemic complications acutely and at 1 mouth after the procedure. Therefore, low osmolar ionic contrast media should be strongly certified when performing interventions in patients with unstable angina or myocardial infarction.
Footnotes
☆ This study was supported in part by a grant from Mallinckrodt Medical, Inc., St. Louis, Missouri
- Received August 22, 1995.
- Revision received January 8, 1996.
- Accepted January 17, 1996.
