EFFECTS OF NONIONIC VERSUS IONIC CONTRAST-MEDIA ON COMPLICATIONS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

To evaluate the effect of contrast agents on percutaneous transluminal coronary angioplasty (PTCA) complications, 913 patients undergoing 1,058 separate PTCA procedures were prospectively randomized to receive either nonionic iopamidol (Isovue-370(R)) [n = 507 PTCA procedures] or ionic contrast media, meglumine sodium diatrizoate (Renografin-76(R)) [n = 551 PTCA procedures]. Angioplasty operators, technicians, nurses and patients were blinded to the agent used. All patients were pretreated with 0.6 mg of atropine sulfate intravenously before any contrast injections. Hypotension (mean arterial pressure < 65 mm Hg associated with contrast injections) occurred during 8.5% of PTCA procedures in which the patients were receiving iopamidol and during 9.5% of the procedures in which the patients were given diatrizoate (difference not significant). Bradycardia (heart rate of < 40 beats/min associated with contrast injections) developed during 5.7% of procedures when patients were given iopamidol and during 5.1% of procedures when patients were given diatrizoate (difference not significant). The need for additional atropine or temporary pacing during the procedure was similar for patients given iopamidol and diatrizoate. The overall incidence of ventricular tachycardia or fibrillation, or both, during the procedure occurred less frequently when iopamidol was used compared with diatrizoate (1 vs 2.5%, p = 0.045). These serious ventricular arrhythmias were attributable to contrast injections in 0.6% of the PTCA procedures when iopamidol was given and in 2.0% of the cases in which diatrizoate was the contrast agent (p = 0.09). Only 1 patient had an allergic reaction to the contrast agent, and this was in a patient who received iopamidol. There were no differences in hospital complications (myocardial infarction, emergency coronary artery bypass grafting, or death) between the 2 groups. It is concluded that in patients undergoing PTCA, iopamidol (Isovue-370(R)), compared with meglumine sodium diatrizoate (Renografin-76(R)), reduces the overall incidence of serious ventricular arrhythmias but not the frequency of myocardial infarction, the need for surgery, or death.