Comparison between Iodixanol (Visipaque (R)) and Ioxaglate (Hexabrix (R)) for coronary angiography and ventriculography: a double-blinded randomized study

Objective :To evaluate and compare in a double-blinded and prospective stud y the incidence of adverse reactions between two contrast agents used for c oronary angiography and ventriculography. The first agent was the non-ionic , dimeric, isotonic contrast medium iodixanol (Visipaque(R)), the other was the ionic dimeric contrast medium ioxaglate (Hexabrix(R)). Methods : A total of 110 consecutive patients were randomized and received either iodixanol 320 mgl/ml or ioxaglate 320 mgl/ml. The efficacy, safety, tolerability and specific cardiovascular effects were evaluated. Adverse re actions were recorded during the procedure and during the first 24 hours af ter the examination. Hemodynamic and electrophysiological parameters were r ecorded before and after the ventricular injection and the first injections into the left and right coronary artery, respectively Results : The incidence of clinical adverse reactions was significantly dif ferent between iodixanol and ioxaglate (3% vs 28%, p = 0.0004). 24 patients (16 iodixanol; 8 ioxaglate) experienced no discomfort (sensation of warmth , coldness or pain), and the intensity of discomfort experienced by the rem ainder was similar for the two groups. No patient reported pain. During the 3 minutes after injection of contrast medium, the LV end-diastol ic pressure increased but, apart from one reading, the increases with iodix anol were always significantly different (p < 0.05), and less than those fo r ioxaglate. During the same time period, heart rate was increased to a gre ater extent by ioxaglate (p < 0.05). QT interval was significantly (p < 0.0 5) prolonged with both ioxaglate and iodixanol, but the changes were less m arked after iodixanol. The angiographic studies were of diagnostic quality for all patients and op timal diagnostic information was achieved in 92% of both groups. Conclusion: This randomized study shows that iodixanol and ioxaglate are of comparable diagnostic efficacy in coronary angiography and ventriculograph y, but that iodixanol is better tolerated by patients and results in less m arked hemodynamic and eletrophysiological changes than does ioxaglate.