901-14 Impact of Ionic and Non-ionic Contrast Media on Post-PTCA Ischemic Complications: Results from the EPIC Trial

Previous studies have demonstrated greater thrombogenic properties and higher rates of post-PTCA ischemic complications with use of non-ionic (NI) compared to ionic (I) contrast media. To assess the role of I vs NI contrast media on thrombus formation and ischemic complications, we prospectively evaluated the post-PTCA outcome of 1,930 patients who were enrolled in the EPIC trial. Patients were enrolled if presenting with acute MI (≤7 days), unstable angina, or had high risk angiographic characteristics. Patients received aspirin (325 mg), procedural heparin, and either placebo infusion (n = 637) or a glycoprotein IIB/IIIA receptor antibody, c7E3Fab (n = 1293). I and NI were used in 257 and 380 patients receiving placebo and in 505 and 708 patients receiving c7E3Fab, respectively. More patients receiving NI were enrolled with acute MI (3.5% vs 1.4%), and more patients receiving I had unstable angina (26.1% vs 22.4%). Other baseline and procedural characteristics were similar between patient groups. Outcome Placebo c7E3Fab Ionic (n = 257) Non-ionic (n = 380) Ionic (n = 505) Non-ionic (n = 788) Post-PTCA thrombus (%) 17 18 15 15 Q-wave MI (%) + 1.6 32 0.2 1.4 Emergent CABG (%) + 2.7 4.5 2.0 2.5 Death (%) + 0.4 1.6 0.4 1.4 + in-hospital; MI = myocardial infarction; CABG = coronary bypass surgery After controlling for c7E3Fab randomization by logistic regression, ionic contrast agents were associated with a lower probability of Q-wave MI (odds ratio: 0.32; p = 0.012) and death (odds ratio: 0.27; p = 0.016). These preliminary data suggest that the selection of ionic contrast media during PTCA should strongly be considered.