Association between Contrast Media Volume and 1-Year Clinical Outcomes in Patients Undergoing Coronary Angiography

Ying-Qing Feng, Xu-Yu He, Fei-Er Song, Ji-Yan Chen, Ying-Qing Feng, Xu-Yu He, Fei-Er Song, Ji-Yan Chen

Abstract

Background: The excess volume of contrast media (CM) is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events (MACCE) and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography (CAG).

Methods: We prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis.

Results: The cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 (≤100 ml), Q2 (101-140 ml), Q3 (141-200 ml), and Q4 (>200 ml), respectively (P < 0.001). Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively (P < 0.001). The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used >140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml (P = 0.007).

Conclusion: Our data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization.

Trial registration: ClinicalTrials.gov, NCT01735305; https://ichgcp.net/clinical-trials-registry/NCT01735305?id=NCT017353057rank=1.

Keywords: Bleeding; Cerebrovascular Event; Contrast Media; Coronary Artery Disease.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
Incidence of MACCE (a), revascularization (b), and all bleeding by categories of CM volume quartiles (c) in the entire study population. The Y-axis scale is different in each category and reflects the difference in baseline risk among different clinical outcomes). MACCE: Major adverse cardiac and cerebrovascular event; CM: Contrast media.
Figure 2
Figure 2
Unadjusted and adjusted ORs of the logistic regression model for MACCE (a and b), revascularization (c and d), and all bleeding (e and f) when Q2, Q3, and Q4 compared to Q1 as the reference (OR = 1.00). Blue: Q2, Orange: Q3, Gray: Q4. “×” in the figures means regression analysis OR value. ORs: Odds ratios; MACCE: Major adverse cardiac and cerebrovascular event.
Figure 3
Figure 3
Kaplan-Meier curves showing the cumulative probability of MACCE (a) (log rank P < 0.001), all bleeding (b) (log rank P < 0.001), stroke (c) (log rank P = 0.739), revascularization (d) (log rank P < 0.001), all-cause mortality (e) (log rank P = 0.117), and MI (f) (log rank P = 0.019) and according to the CM volume quartiles. MACCE: Major adverse cardiac and cerebrovascular event; CM: Contrast media; MI: Myocardial infarction.

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