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Catheter Cardiovasc Interv. 2019 Feb 1;93(2):222-230. doi: 10.1002/ccd.27819. Epub 2018 Aug 25.

Contemporary use of and outcomes associated with ultra-low contrast volume in patients undergoing percutaneous coronary interventions.

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Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Beaumont Hospital Royal Oak, Royal Oak, Michigan.
St. John Hospital, Detroit, Michigan.
McLaren Northern Michigan, Petoskey, Michigan.
Mercy Health, Muskegon, Michigan.
Frederick Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan.



The risk of contrast-induced acute kidney injury (CI-AKI) increases in a nonlinear fashion with increasing volume of contrast media. Prior studies recommend limiting contrast volume to less than three times the estimated creatinine clearance (CC). Recently, a number of operators have reported successful percutaneous coronary intervention (PCI) using even lower volumes of contrast.


To evaluate the prevalence and outcomes associated with ultra-low contrast volume among patients undergoing PCI.


We assessed the prevalence and outcomes associated with use of ultra-low contrast volume among 75 393 patients undergoing PCI in Michigan between July 2014 and June 2017 in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry. Ultra-low contrast volume was defined as contrast volume less than or equal to the patient's estimated CC. Patients receiving dialysis at the time of the procedure were excluded.


Ultra-low contrast volume was used in 13% of procedures with the majority of these patients being at low risk of renal complications. Compared with patients who received a contrast volume between one and three times the CC, use of ultra-low volume of contrast was associated with a significantly lower incidence of AKI (aOR 0.682, 95% CI 0.566-0.821, P < 0.001) and a lower incidence of need for dialysis (aOR = 0.341, 95% CI 0.165-0.704, P = 0.003). These benefits were most evident in the patients with a high baseline predicted risk of AKI.


A small but clinically significant number of patients are treated with ultra-low contrast volume. Ultra-low contrast volume use is associated with a significant reduction in the incidence of AKI or need for dialysis. It may be prudent to consider this new threshold when performing PCI on patients who are at an increased risk of AKI.


PCI; comparative effectiveness/patient centered outcomes research; complications; contrast agent; health care outcomes; percutaneous coronary intervention; renal disease


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