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Contrast-induced nephropathy (CIN) is an important cause of iatrogenic morbidity and mortality. The amount of contrast delivered is dependent on the complexity of the procedure and operator technique, and has a major impact on the incidence of CIN. It is unclear whether the use of automatic systems can reduce contrast volumes when low volumes are routinely used.
An automatic injector was introduced to one of our three cardiac catheterization labs in January 2011. From January 31 to May 31, 2011, 1358 consecutive patients undergoing diagnostic catheterizations and percutaneous coronary interventions (PCI) were randomly allocated to one of the three labs. Manual stopcock-manifold contrast injection was used in 1052 patients and automated contrast injection in 306 patients.
Baseline and procedural characteristics in both groups were similar. There was no significant difference in contrast volume between manual and automated contrast injection systems. (Figure) The incidence of CIN following PCI was 9.8% in the manual group and 7.4% with automatic injector (p=0.43). Use of automated contrast injector was associated with a decrease in contrast use only among operators that routinely use large-caliber (7F) catheters (Manual 206.5mL vs Automated 161.4mL, p=0.005).
The use of automated contrast injection for coronary angiography and PCI is not associated with reduced contrast volume as compared to manual injection. Beneficial effect may be seen when higher contrast volumes or large-caliber catheters are routinely used.
- 2012 American College of Cardiology Foundation