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European Heart Journal 2001 22(5):385-391; doi:10.1053/euhj.2000.2319
Copyright © 2001 by the European Society of Cardiology.
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Acute and subacute stent occlusion; risk-reduction by ionic contrast media

B Schellera,f1, B Hennena, A Pohlb, H Schieffera and T Markwirtha

a Division of Internal Medicine III (Department of Cardiology), University of Saarland, Homburg/Saar, Germany
b Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, U.S.A.

Abstract

Aims Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (≤72h) and subacute (≤30 days) stent thrombosis has not been investigated.

Methods Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention.

Results Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1·3% in group I vs 0·3% in group II, P=0·001; subacute stent occlusion: 2·4% in group I vs 0·7% in group II, P=0·001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22·9% vs 16·3%,P =0·001).

Conclusions Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated.

Key Words: X-ray contrast media, coronary stent, thrombosis

f1 Correspondence: Bruno Scheller, MD, Innere Medizin III, Universitätskliniken des Saarlandes, D 66421 Homburg/Saar, Germany

References

  1. Machraoui A, Hinrichsen M, Jäger D. Unverträglichkeitsreaktionen auf ionische und nichtionische Kontrastmittel in der Herzdiagnostik. Eine randomisierte Doppelblind-Studie. Dtsch Med Wschr. 1991;116:321–326[Medline]
  2. Hellige G, Vogel B, Tebbe U, Kreuzer H. Kontrastmittel in der Kardiologie. Bericht uber eine randomisierte, doppelblinde multizentrische Vergleichsstudie uber die Nebenwirkungen von ionischem und nichtionischem Rontgenkontrastmittel (K.I.K.-Studie). Z Kardiol. 1992;81:290–292[ISI][Medline]
  3. Hill JA, Winniford M, Cohen MB. Multicenter trial of ionic versus nonionic contrast media for cardiac angiography. The Iohexol Cooperative Study. Am J Cardiol. 1993;72:770–775[CrossRef][ISI][Medline]
  4. Fransson SG, Stenport G, Andersson M. Immediate and late adverse reactions in coronary angiography. A comparison between iodixanol and ioxaglate. Acta Radiol. 1996;37:218–222[ISI][Medline]
  5. Scheller B, Heib KD, Müller M, Jung F, Schieffer H, Özbek C. Röntgenkontrastmittel in der invasiven Kardiologie, Nebenwirkungen und differenzierter Einsatz. Z Kardiol. 1998;87:545–552[CrossRef][ISI][Medline]
  6. Stormorken H. Effects of contrast media on the hemostatic and thrombotic mechanisms. Investigative Radiology. 1988;23:318
  7. Grabowski EF, Head C, Michelson AD. Nonionic contrast media. Procoagulants or clotting innocents? Invest Radiol. 1993;28:S21–S24
  8. Piessens JH, Stammen F, Vrolix MC. Effects of an ionic versus a nonionic low osmolar contrast agent on the thrombotic complications of coronary angioplasty. Cathet Cardiovasc Diagn. 1993;28:99–105[ISI][Medline]
  9. Gasperetti CM, Feldman MD, Burwell LR. Influence of contrast media on thrombus formation during coronary angioplasty. J Am Coll Cardiol. 1991;18:443–450[Abstract]
  10. Batchelor, WB, Granger, CB, Kleiman, N, for the GUSTO IIb Investigators. A comparison of ionic versus nonionic contrast medium during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction (GUSTO IIb), Am J Cardiol 2000, 85, 692, 7
  11. Grines CL, Schreiber TL, Savas V. A randomized trial of low osmolar ionic versus nonionic contrast media in patients with myocardial infarction or unstable angina undergoing percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 1996;27:1381–1386[Abstract]
  12. Qureshi N, denHeijer P, Crijns HJ. Percutaneous coronary angioscopic comparison of thrombus formation during percutaneous coronary angioplasty with ionic and nonionic low osmolality contrast media in unstable angina. Am J Cardiol. 1997;80:700–704[CrossRef][ISI][Medline]
  13. Lefèvre T, Adjeroud N, Royer T, Glatt B, Morice MC. Influence of contrast media on the results of percutaneous transluminal coronary angioplasty with provisional stenting: a comparative study. J Invas Cardiol. 1998;10:380–384[ISI][Medline]
  14. Schräder R, Esch I, Ensslen R. A randomized trial comparing the impact of a nonionic (Iomeprol) versus an ionic (Ioxaglate) low osmolar contrast medium on abrupt vessel closure and ischemic complications after coronary angioplasty. J Am Coll Cardiol. 1999;33:395–402[Abstract/Free Full Text]
  15. Scharf RE, Tomer A, Marzec UM, Teirstein PS, Ruggeri ZM, Harker LA. Activation of platelets in blood perfusing angioplasty-damaged coronary arteries. Flow cytometric detection. Arterioscler Thromb. 1992;12:1475–1478[Abstract/Free Full Text]
  16. Neumann FJ, Ott I, Gawaz M, Puchner G, Schomig A. Neutrophil and platelet activation at balloon-injured coronary artery plaque in patients undergoing angioplasty. J Am Coll Cardiol. 1996;27:819–824[Abstract]
  17. Gawaz M, Neumann FJ, Ott I, May A, Schomig A. Platelet activation and coronary stent implantation. Effect of antithrombotic therapy. Circulation. 1996;94:279–285[Abstract/Free Full Text]
  18. Chronos NA, Goodall AH, Wilson DJ, Sigwart U, Buller NP. Profound platelet degranulation is an important side effect of some types of contrast media used in interventional cardiology. Circulation. 1993;88:2035–2044[Abstract/Free Full Text]
  19. Hay K, Bull S. An analysis of platelet activation and aggregation produced by three classes of contrast media. JVIR. 1995;6:211–217[ISI][Medline]
  20. Sane DC, Moser T, Bashore T, Wagner C, Greenberg C. Diatrizoate-containing contrast media inhibit platelet aggregation by disrupting fibrinogen binding. Coron Art Dis. 1991;2:389–396
  21. Fay WP, Parker AC. Effects of radiographic contrast agents on thrombin formation and activity. Thromb Haemost. 1998;80:266–272[ISI][Medline]
  22. Melton LG, Dehmer GJ, Gabriel DA. Alterations in fibrin detected in coronary sinus blood after heparin and coronary angiography with a nonionic contrast agent (iohexol). Am J Cardiol. 1998;82:295–298[CrossRef][ISI][Medline]
  23. Pislaru S, Pislaru C, Szilard M, Arnout J, Van de Werf F. In vivo effects of contrast media on coronary thrombolysis. J Am Coll Cardiol. 1998;32:1102–1108[Abstract/Free Full Text]
  24. Esplugas E, Cequier A, Jara F. Risk of thrombosis during coronary angioplasty with low osmolality contrast media. Am J Cardiol. 1991;68:1020–1024[CrossRef][ISI][Medline]
  25. Corot C, Cornillac A, Belleville J, Eloy R. Scanning electron microscopic analysis of catheters during routine angiographic procedures. Role of the contrast agent. The European Clotting Group. Invest Radiol. 1991;26:S96–100
  26. Casalani E. Role of low-osmolality contrast media in thromboembolic complications: scanning electron microscopy study. Radiology. 1992;183:741–744[Abstract/Free Full Text]
  27. Willerson JT, Golino P, Eidt J, Campbell WB, Buja LM. Specific platelet mediators and unstable coronary artery lesions. Experimental evidence and potential clinical implications. Circulation. 1989;80:198–205[Abstract/Free Full Text]
  28. Bertrand ME, Esplugas E, Piessens J, Rasch W. Influence of a nonionic, iso-osmolar contrast medium (iodixanol) versus an ionic, low-osmolar contrast medium (ioxaglate) on major adverse cardiac events in patients undergoing percutaneous transluminal coronary angioplasty: A multicenter, randomized, double-blind study. Visipaque in Percutaneous Transluminal Coronary Angioplasty VIP Trial Investigators. Circulation. 2000;101:131–136[Abstract/Free Full Text]
  29. Ip JH, Fuster V, Israel D, Badimon L, Badimon J, Chesebro JH. The role of platelets, thrombin and hyperplasia in restenosis after coronary angioplasty. J Am Coll Cardiol. 1991;17:77B–88B[Medline]

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