Abstract 3913: The Critical Role of a Weight and Creatinine Adjusted Contrast Dose on Fatal and Non-Fatal Adverse Outcomes on Percutaneous Coronary Intervention
Background: Prior studies have shown that exceeding a maximum weight and creatinine (Cr) adjusted contrast dose threshold (MACD) during percutaneous coronary intervention (PCI) is associated with a marked increase in contrast induced nephropathy and nephropathy requiring dialysis. The objective of our study was to determine the relationship between exceeding this dose and other fatal and non-fatal adverse outcomes of PCI.
Methods: The study sample included 9,677 patients with chronic renal insufficiency (CRI) undergoing PCI in a large multicenter PCI registry. CRI was defined as admission Cr≥1.5 mg/dL. 1,440 patients who were on dialysis prior to admission were excluded. Exceeding the MACD was defined as exceeding the quantity [weight (kg) * 5]/[baseline Cr (mg/dL)]. End-points evaluated included contrast induced nephropathy (CIN) defined as a Cr increase over baseline ≥ 0.5 mg/dL, in-hospital death, stroke/TIA, CABG, MI, repeat revascularization, and a combined major adverse cardiovascular endpoint (MACE). Multivariate logistic regression modeling was used to adjust for comorbidities and for propensity of exceeding the MACD.
Results: Exceeding the MACD was associated with significantly higher rates of CIN (20.1% vs. 10.5%, p<0.0001), death (6.69 vs. 2.95, p<0.0001), stroke/TIA (1.35 vs. 0.67, p=0.003), post-procedure MI (3.73 vs. 2.18, p<0.0001) and MACE (12.62 vs. 6.97, p<0.0001). There were no significant differences in the rate of CABG and revascularization. After adjustment for comorbidities and for propensity of exceeding the MACD, exceeding the MACD was associated with significantly higher odds of CIN, Death, MI and MACE (Table 1⇓).
Conclusions: Exceeding a weight and creatinine MACD threshold during PCI is associated with increased risk adverse outcomes of PCI in patients with CRI. It remains to be determined whether modification of procedure strategies to reduce the contrast dose might result in improved outcomes for patients with CRI.