COMPLICATIONS OF CARDIAC ANGIOGRAPHY USING LOW-OSMOLALITY OR HIGH-OSMOLALITY CONTRAST AGENTS IN PATIENTS WITH LEFT MAIN CORONARY STENOSIS

Recently published guidelines suggest that, in view of cost concerns, low-osmolal contrast should be selectively used in patients at increas ed risk of experiencing a contrast-related complication during cardiac angiography. The suggested criteria include the presence of left main coronary disease. However, the presence of left main disease is not u sually known prior to angiography. Contrast-related complications of c ardiac angiography were therefore analyzed in a group of 111 clinicall y stable patients found to have left main coronary stenosis, to determ ine if use of low-osmolality contrast had any beneficial effect when c ompared to standard contrast. Data were gathered prospectively as part of a randomized controlled trial, and the subgroup of patients with l eft main disease was analyzed retrospectively. Complications were divi ded into minor, intermediate, and major categories. In the 58 patients who received high-osmolar contrast, there were 4 contrast-related min or reactions, 8 intermediate events requiring treatment, and 1 major a dverse event. Among the 53 patients who received low-osmolar contrast, there were no minor reactions, 7 intermediate events requiring treatm ent, and no major adverse events. The only difference of borderline si gnificance was in the incidence of minor reactions requiring no treatm ent (P = 0.05). Although small and therefore not definitive, this stud y suggests that 1) universal use of low-osmolar contrast agents would not be expected to eliminate the risk of contrast-related reactions to cardiac angiography; 2) the well-documented clinical differences betw een high- and low-osmolar contrast primarily involve mild reactions; a nd 3) standard high-osmolar contrast is reasonably safe in clinically stable patients with left main coronary stenosis. The results therefor e are consistent with the notion that selective use of low-osmolar con trast only in unstable patients is safe and appropriate. (C) 1997 Wile y-Liss, Inc.