MULTICENTER TRIAL OF IONIC VERSUS NONIONIC CONTRAST-MEDIA FOR CARDIACANGIOGRAPHY

Contrast agents used for cardiac angiography are different in regard t o ionicity, osmolality and physiologic effects. The nonionic contrast media have been shown to have less toxic effects and a better safety p rofile than do higher osmolar agents. To better assess this risk, clin ically stable patients undergoing cardiac angiography were stratified according to the presence of diabetes mellitus, and level of serum cre atinine, and then randomized to receive either iohexol (Omnipaque 350( TM)) or sodium meglumine diatrizoate (Renografin 76(TM)). All adverse events that occurred during and immediately after angiography were tab ulated. A multivariate model was used to identify patients at increase d risk for adverse outcome. The 1,390 patients were randomized to iohe xol (n = 696) or diatrizoate (n = 694). Significant differences were f ound in the number of patients with contrast media-related adverse (io hexol vs diatrizoate: 10.2 vs 31.6%; p < 0.001) and cardiac adverse (7 .2 vs 24.5%; p < 0.001) events. Severe reactions and the need for trea tment were more frequent with diatrizoate than with iohexol, but there was no difference in the incidence of death. The presence of New York Heart Association classification 3 or 4 and serum creatinine greater- than-or-equal-to 1.5 mg/dl predicted a higher incidence of adverse eve nts as a result of contrast media alone. Use of iohexol is associated with a lower incidence of all types of adverse events during cardiac a ngiography than is diatrizoate.