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Contrast agent dose and slow/no-reflow in percutaneous coronary interventions

A case-control study of patients with non-ST-segment elevation acute coronary syndromes
  • S. Ding
  • Y. Shi
  • X. Sun
  • Q. Cao
  • H. Dai
  • J. Guan
Original articles
  • 50 Downloads

Abstract

Background

The angiographic slow/no-reflow phenomenon after primary percutaneous coronary intervention carries a poor prognosis for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). There is evidence that contrast agents cause endothelial dysfunction, myocardial cell damage, and coronary spasms. We hypothesized that the contrast agent dose may be related to slow/no-reflow in patients with NSTEACS undergoing percutaneous transluminal coronary angioplasty and stent (PTCA + stent).

Patients and methods

We enrolled 3369 patients with NSTEACS who underwent PTCA + stent only in the culprit vessel for the first time from September 2007 to May 2017 in this study. Coronary blood flow of ≤TIMI grade 2 after PTCA + stent was defined as slow/no-reflow. The relationship between the contrast agent dose and slow/no-reflow phenomenon was analyzed by multivariate conditional logistic regression and smooth curve fitting.

Results

In multivariable conditional logistic regression analysis, the contrast agent dose was found to be an independent risk factor for slow/no-reflow after adjusting for the number of stents and the thrombus burden (OR: 1.0112; 95% CI: 1.0049–1.0176; p < 0.0001), and after adjusting for type 2 diabetes mellitus, NSTEACS risk stratification, application of platelet glycoprotein (GP) IIB/IIIA receptor antagonists, type of contrast agent, number of balloon dilatations, number of stents, and thrombus burden (OR: 1.0113; 95% CI: 1.0036–1.0191; p = 0.004). Further, the risk of slow/no-reflow increased significantly with the contrast agent level up to the inflection point of 160 ml.

Conclusion

The contrast agent dose may be a risk factor for slow/no-reflow phenomenon after PTCA + stent in patients with NSTEACS. When the dose was greater than 160 ml, the risk of slow/no-reflow increased significantly.

Keywords

Acute coronary syndrome Percutaneous transluminal coronary angioplasty Stents Contrast material Coronary circulation 

Kontrastmitteldosis und geringer oder kein Rückfluss bei perkutaner Koronarintervention

Fall-Kontroll-Studie an Patienten mit akutem Koronarsyndrom ohne ST-Strecken-Hebung

Zusammenfassung

Hintergrund

Das angiographische Phänomen des geringen oder fehlenden Rückflusses nach primärer perkutaner Koronarintervention geht mit einer schlechten Prognose für Patienten mit akutem Koronarsyndrom ohne ST-Strecken-Hebung („non-ST-segment acute coronary syndrome“, NSTEACS) einher. Es gibt Belege dafür, dass Kontrastmittel eine endotheliale Dysfunktion, Myokardzellschädigungen und Koronarspasmen verursachen. Die Autoren stellten die Hypothese auf, dass die Kontrastmitteldosis mit geringem oder fehlendem Rückfluss bei Patienten mit NSTEACS und perkutaner transluminaler Koronarangioplastie und Stentimplantation (PTCA + Stent) in Zusammenhang stehen könne.

Patienten und Methoden

Es wurden 3369 Patienten mit der Diagnose eines NSTEACS in die vorliegende Studie aufgenommen, bei denen von September 2007 bis Mai 2017 zum ersten Mal eine PTCA + Stent allein im ursächlichen Gefäß durchgeführt wurde. Ein Blutfluss  ≤ TIMI 2 (Thrombolysis-in-Myocardial-Infarction-Klassifikation) nach PTCA + Stent wurde definiert als geringer oder fehlender Rückfluss. Der Zusammenhang zwischen der Kontrastmitteldosis und dem Phänomen des geringen/fehlenden Rückflusses wurde mit multivariater konditionaler logistischer Regressionsanalyse und entsprechender Kurvenanpassung ermittelt.

Ergebnisse

In der multivariaten konditionalen logistischen Regressionsanalyse stellte sich die Kontrastmitteldosis als ein unabhängiger Risikofaktor für geringen/fehlenden Rückfluss nach Berücksichtigung der Anzahl von Stents und der Thrombuslast (OR: 1,0112; 95% KI: 1,0049–1,0176; p < 0,0001) heraus sowie nach Berücksichtigung von Diabetes mellitus Typ 2, NSTEACS-Risikostratifizierung, Gabe von Glykoprotein(GP)-IIB/IIIA-Rezeptorantagonisten, Art des Kontrastmittels, Anzahl der Ballondilatationen, Anzahl von Stents und der Thrombuslast (OR: 1,0113; 95% KI: 1,0036–1,0191; p = 0,004). Darüber hinaus stieg das Risiko für einen geringen/fehlenden Rückfluss signifikant mit der Dosis des Kontrastmittels bis zum Wendepunkt von 160 ml.

Schlussfolgerung

Die Dosis des Kontrastmittels kann einen Risikofaktor für das Phänomen des geringen/fehlenden Rückflusses nach PTCA + Stent bei NSTEACS-Patienten darstellen. Das Risiko eines geringen/fehlenden Rückflusses stieg signifikant bei einer Dosis von mehr als 160 ml.

Schlüsselwörter

Akutes Koronarsyndrom Perkutane transluminale Koronarangioplastie Stents Kontrastmittel Koronarzirkulation 

Notes

Acknowledgements

We thank Prof. Changzhong Chen, Medical Collage of Harvard University, Prof. Jian Gao, Evidence-Based Medicine Center of Fudan University, Prof. Xinglin Chen and Prof. Yuntian Chu, Empower College, for the guidance and assistance in the experimental design and statistical analysis.

Compliance with ethical guidelines

Conflict of interest

S. Ding, Y. Shi, X. Sun, Q. Cao, H. Dai, and J. Guan declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the committee of Qingdao Eighth People’s Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • S. Ding
    • 1
    • 3
  • Y. Shi
    • 2
  • X. Sun
    • 3
  • Q. Cao
    • 3
  • H. Dai
    • 2
  • J. Guan
    • 2
  1. 1.Medical CollegeQingdao UniversityQingdaoChina
  2. 2.Department of CardiologyQingdao Municipal HospitalQingdaoChina
  3. 3.Department of CardiologyQingdao Eighth People’s HospitalQingdaoChina

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