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The BMC2 Trial

Source

Reed MC, Moscucci M, Smith DE, et al. The relative renal safety of iodixanol and low-osmolar contrast media in patients undergoing percutaneous coronary intervention. Insights from Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). J Invasive Cardiol. 2010;22(10):467–472.

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Background

Contrast-induced acute kidney injury [(CI-AKI) (serum creatinine ≥0.5 mg/dL)], a well-described complication of percutaneous coronary intervention (PCI) is associated with increased morbidity, mortality and healthcare cost. Iso-osmolar contrast medium, iodixanol and low-osmolar contrast media (LOCM) result in less nephrotoxicity and have been used as effective preventative measures against CI-AKI as compared to older-generation high-osmolar contrast media. As per recent trials and meta-analyses iodixanol when compared to LOCM shows no difference in CI-AKI. Given the widespread use of iodixanol and LOCM in PCI, this study evaluates how often each type of contrast media is being used, and whether iodixanol improves patient outcomes in common practice – particularly in patients with pre-existing chronic kidney disease.

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Aim

To analyze the impact of iodixanol compared to various LOCM.

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Key results

• Patients treated with iodixanol compared to those treated with LOCM were slightly older, had more medical co-morbidities and a higher baseline creatinine (1.35±1.07 mg/dL vs 1.10±0.85 mg/dL; p<0.0001).

• After adjusting for baseline differences and clustering, there was no difference in the incidence of CI-AKI (OR: 1.09, CI: 0.97–1.23), in-hospital need for dialysis (OR: 0.85, CI: 0.60–1.20) or in-hospital death (OR: 1.05, CI: 0.87–1.26) (Table 1).

• In propensity-matched, risk-adjusted models, there was no significant difference between iodixanol and LOCM in the risk of CI-AKI (4.54% vs 4.14%; p=0.14), need for dialysis (0.37% vs 0.43%; p=0.35) or death (1.46% vs 1.39%; p=0.18).

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Conclusion

This study evaluated the use of contrast media in patients undergoing PCI in current clinical practice. Data suggested that iodixanol was a widely used contrast medium, particularly in high-risk patients, but that the use of iodixanol does not seem to influence the risk of CI-AKI, in-hospital hemodialysis, or in-hospital death. No advantage or disadvantage of iodixanol was found, with respect to renal outcome compared to LOCM.

The risk of CI-AKI is same with use of either iodixanol as compared to LOCM.