Author + information
- Reza Arsanjani,
- Ryo Nakazato,
- Aryeh Shalev,
- Millie Gomez,
- Heidi Gransar,
- Jonathon Leipsic,
- Daniel Berman and
- James Min
The aim of the study was to compare the diagnostic accuracy, image quality and patient comfort for coronary CT angiography (CCTA) performed using low versus high iodine content contrast.
Patients referred for invasive coronary angiography (ICA) were randomly assigned to investigational CCTA using iodixanol 370 mg/dl contrast. Diagnostic performance to identify or exclude obstructive coronary stenosis (>70% luminal diameter stenosis) was assessed employing quantitative coronary angiography (QCA) as a reference standard. Obstructive stenosis presence by CCTA was determined by consensus of 2-blinded expert readers, and by QCA using standard software by an expert blinded core laboratory. Image quality was similarly assessed using a 5-point Likert scale. We further compared patient comfort between groups, defined by a composite endpoint of pain at injection site, hypotension, palpitations, lightheadedness, and/or chest discomfort. Patient comfort was ascertained by patient report immediately after CCTA using a 10-point scale, and categorized as none (0), mild (1-3), moderate (4-7) or severe (8-10).
A total of 266 subjects underwent both CCTA and ICA (56.7 + 11.3 years, 57.5% male). Baseline characteristics between the 2 groups were similar. Evaluation of diagnostic accuracy, sensitivity, specificity, positive and negative predictive values to diagnose > 70% stenosis rendered similar values, 93%, 79%, 98%, 94%, 92% and 95%, 87%, 98%, 94%, 95% for iodixanol and iopamidol, respectively. Image quality was considered good or excellent in 88% of cases for iodixanol and 82.5% for iopamidol (p=0.38). Iopamidol patients experienced a greater frequency of moderate or severe flushing symptoms as compared to iodixanol patients (p=0.003). Differences in any patient symptoms between iodixanol and iopamidol groups were particularly evident for individuals > 55 years (p=0.015).
In this prospective multicenter randomized controlled trial, diagnostic accuracy and image quality were similar for CCTA performed with low versus high iodine contrast. Patients tolerated the low-iodine contrast better.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: CT/Multimodality IX
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1314M-350
- 2013 American College of Cardiology Foundation