New ACC registry data suggests interventional cardiologists are using less contrast for PCI procedures in the cath lab which helps reduce post-PCI acute kidney injury risks, but a deeper look tells us there’s still room for improvement.
- Iodinated contrast agents are commonly used for PCI with gadolinium-based contrast serving as an alternative but both can cause complications like acute kidney injury.
- However, the trend is shifting towards minimizing or avoiding contrast use, especially in high-risk patients, through techniques like “zero-contrast” or “ultra-low contrast” PCI.
Searching for cath lab trends, researchers examined 3.12M unique PCI procedures performed by 3.6k physicians from 2018 to 2022 and found that the average contrast volume used during PCI decreased modestly but consistently over the study’s four years.
- Overall mean PCI contrasts volumes decreased from 168.1 mL in 2018 to 71.2 mL by 2022.
- Encouragingly, patients at higher preprocedural AKI risk also consistently received less contrast than those at lower risk (160.5 mL vs. 171.3 mL in 2018 down to 143.4 mL vs. 150.4 mL in 2022).
While the trend is in the right direction, researchers still highlighted that there’s plenty of room for improvement across the board.
- For example, 37.5% of physicians did not significantly decrease their contrast use during the four years they were followed, while 20% didn’t change volumes at all.
- When categorized by percent change, 77.1% did not significantly change the amount of contrast they used per procedure.
- Meanwhile, 1.9% of physicians actually increased their average contrast by >20%.
So what’s the answer? One recent RCT in Canada implemented preprocedural guidelines for safe contrast amounts and showed decreases in both contrast volume and AKI, particularly in higher-risk patients.
- However, the trial provided feedback at the individual operator level rather than at the site level, so it’s unknown if site-level feedback alone can reduce AKI rates.
The Takeaway
PCI contrast use is headed in the right direction, but there’s still work to be done when it comes to messaging and convincing physicians about reducing volumes during procedures. Whether that’s achieved by more research, a better contrast alternative, or stronger education remains to be seen.
