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4 Renal function-based contrast dosing to define ‘prognostic’ contrast limits in patients undergoing coronary angioplasty
  1. Navin Chandra1,2,
  2. Imad Nadra1,2,
  3. Lillian Ding3,
  4. Sean Hardiman3,
  5. Anthony Fung4,
  6. Eve Aymong5,
  7. John Webb5,
  8. David Wood5,
  9. Sean Virani5,
  10. Albert W Chan6,
  11. Tycho Vuurmans6,
  12. Steven Hodge7,
  13. Kevin Horgan3,
  14. Habib Mawad8,
  15. Adeera Levin5,
  16. Eric Fretz1,2,
  17. Simon D Robinson1,2,
  18. Anthony Della Siega1,2,
  19. M Bilal Iqbal1,2
  1. 1Victoria Heart Institute Foundation, Victoria, BC, Canada
  2. 2Royal Jubilee Hospital, Victoria, BC, Canada
  3. 3Provincial Health Services Authority, Vancouver, BC, Canada
  4. 4Vancouver General Hospital, Vancouver, BC, Canada
  5. 5St. Paul’s Hospital, Vancouver, BC, Canada
  6. 6Royal Columbian Hospital, Vancouver, BC, Canada
  7. 7Kelowna General Hospital, Kelowna, BC, Canada
  8. 8McGill University, Montreal, QC, Canada


Background Renal function-based contrast dosing minimises renal injury following percutaneous coronary intervention (PCI). The ratio (R) of contrast volume:glomerular filtration rate (GFR) has been studied but its prognostic relevance is unknown.

Aim To establish the relationship between R and mortality; and define a ‘prognostic’ threshold (RT ) for contrast in PCI for stable disease, non ST-elevation ACS (NSTEACS) and ST-elevation ACS (STEACS).

Method We evaluated 44 082 non-dialysis patients between 2008–2014. GFR was calculated using CG, CKD-EPI and MDRD equations. R was determined for each patient and its relationship with mortality was modelled mathematically and analysed using Cox regression and adjusted ROC curve analyses.

Results Multivariable analyses identified R as an independent predictor of 3 year mortality (HR=1.03, 95% CI: 1.02 to 1.04, p<0.001). There was an exponential relationship between R and mortality; for every unit increase in R, 3 year mortality increased by 13%–14% regardless of PCI indication. Adjusted analyses indicated RT was consistently higher in stable disease (RT =7.7–8.3) compared to NSTEACS (RT =5.3–5.7) and STEACS (RT =5.3–5.7).

Conclusion This study advocates a RT =7.7–8.3 for stable disease and RT =5.3–5.7 for NSTEACS/STEACS. This is greater than previously reported but implies greater contrast volumes may ultimately be tolerated in the contemporary PCI era.

Abstract 4 Figure 1

(A) Cox regression analyses (3-year mortality) and (B) Adjusted ROC curve analysis (1,2 and 3-year mortality)

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