Cardiologists using less contrast in the cath lab—but there is room to improve
Interventional cardiologists are slowly using less and less contrast to perform percutaneous coronary intervention (PCI) procedures in the cath lab, according to new registry data from the American College of Cardiology (ACC).
Researchers emphasized that minimizing procedural contrast use is an effective way to reduce the risk of post-PCI acute kidney injury (AKI). The full analysis was published in the Journal of the American College of Cardiology.[1]
The study’s authors explored the ACC’s CathPCI Registry, focusing on more than 3 million patients who underwent PCI from April 2018 to December 2022. Patients received treatment at one of 1,786 U.S. hospitals. The mean age was 66.8 years old, 69.4% were men and 39.9% underwent elective PCI. Patients were excluded if contrast volume data were unavailable or their AKI risk was unknown.
Overall, the mean contrast volume used during PCI decreased from 2018 (168.1 mL) to 2022 (71.2 mL). Researchers described this as a “consistent but modest decline.”
Patients were categorized based on their AKI risk, leaving three groups: low-risk patients, moderate-risk patients and high-risk patients. High-risk patients were consistently associated with receiving less contrast than moderate- or low-risk patients, confirming that clinicians were following industry recommendations.
However, the registry data do suggest there is still room for improvement. For example, 37.5% of physicians did not significantly decrease the amount of contrast they were using from the start of the study to the end of it. Another 9.2% increased their contrast use.
Patients are getting older and undergoing more complex procedures, the group noted, so that may explain the elevated contrast numbers among some clinicians. However, the fact remains that “novel approaches” are required to help further reduce the use of contrast and make PCI even safer for the U.S. heart patients.
“The observation that many interventionalists did not alter their practice patterns over the past five years underscores a compelling need for new strategies to continue and accelerate the modest improvements documented in these analyses,” wrote first author Nobuhiro Ikemura MD, PhD, a cardiologist and researcher with Keio University School of Medicine in Japan, and colleagues. “Implementing strategies to proactively guide safe contrast levels is one strategy to consider … Since U.S. hospitals already receive quarterly site-level AKI rates within CathPCI, integrating additional strategies such as operator-level feedback describing the proportion of their cases treated within safe-contrast limits may further optimize contrast use and improve the safety of PCI.”
Click here for the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.