Nonionic low‐osmolar contrast media have no impact on major adverse cardiac events in patients undergoing coronary stenting with appropriate antiplatelet therapy
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Abstract The aim of this study was to assess the impact of two nonionic low‐osmolar monomers (iopamidol and iopromide) and one ionic low‐osmolar dimeric contrast medium (ioxaglate) on 30‐day major adverse cardiac events in patients undergoing coronary interventions involving the use of new‐generation stents and appropriate antiplatelet agents. Thirteen hundred and eight patients treated with stent implantation were randomized to receive ioxaglate (438 patients), iopamidol (442 patients), or iopromide (428 patients). Most of them (55%) had an acute coronary syndrome. Glycoprotein IIb/IIIa inhibitors were used in 37% of cases. All of the patients were on aspirin and ticlopidine for 1 month after the procedure. There was no significant between‐group difference in the incidence of the primary composite endpoint of major adverse cardiac events 30 days after stenting (ioxaglate 3.6%; iopamidol 2.3%; iopromide 4.2%; P = 0.27). Adverse drug reactions were more frequent in the ioxaglate group (4.6% vs. 1.1% vs. 0.5%; P = 0.001). Multivariate analysis showed that intracoronary thrombus ( P = 0.002), diabetes mellitus ( P = 0.01), and postprocedure minimum lumen diameter ( P = 0.04) independently correlated with an adverse outcome after 1 month. In conclusion, no significant differences in 30‐day major ischemic complications were observed in this unselected population of patients undergoing coronary stenting who received ioxaglate, iopamidol, or iopromide. These data seem to suggest that the use of nonionic low‐osmolar contrast media does not adversely affect stent patency. Catheter Cardiovasc Interv 2003;60:477–482. © 2003 Wiley‐Liss, Inc.Keywords:
Iopromide
Iopamidol
Coronary stent
Ticlopidine
Abstract The aim of this study was to assess the impact of two nonionic low‐osmolar monomers (iopamidol and iopromide) and one ionic low‐osmolar dimeric contrast medium (ioxaglate) on 30‐day major adverse cardiac events in patients undergoing coronary interventions involving the use of new‐generation stents and appropriate antiplatelet agents. Thirteen hundred and eight patients treated with stent implantation were randomized to receive ioxaglate (438 patients), iopamidol (442 patients), or iopromide (428 patients). Most of them (55%) had an acute coronary syndrome. Glycoprotein IIb/IIIa inhibitors were used in 37% of cases. All of the patients were on aspirin and ticlopidine for 1 month after the procedure. There was no significant between‐group difference in the incidence of the primary composite endpoint of major adverse cardiac events 30 days after stenting (ioxaglate 3.6%; iopamidol 2.3%; iopromide 4.2%; P = 0.27). Adverse drug reactions were more frequent in the ioxaglate group (4.6% vs. 1.1% vs. 0.5%; P = 0.001). Multivariate analysis showed that intracoronary thrombus ( P = 0.002), diabetes mellitus ( P = 0.01), and postprocedure minimum lumen diameter ( P = 0.04) independently correlated with an adverse outcome after 1 month. In conclusion, no significant differences in 30‐day major ischemic complications were observed in this unselected population of patients undergoing coronary stenting who received ioxaglate, iopamidol, or iopromide. These data seem to suggest that the use of nonionic low‐osmolar contrast media does not adversely affect stent patency. Catheter Cardiovasc Interv 2003;60:477–482. © 2003 Wiley‐Liss, Inc.
Iopromide
Iopamidol
Coronary stent
Ticlopidine
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RATIONALE AND OBJECTIVES. Since the development of the first low-osmolality contrast agent in 1969, a new group of ionic and nonionic compounds have emerged. These new agents have dramatically improved diagnostic imaging by exhibiting significant improvements in safety and technical efficacy over that of high-osmolality agents. This study was designed to compare the safety, tolerance, and technical efficacy of iopromide, a new low-osmolality, nonionic contrast agent, with that of both ioversol and iopamidol for digital subtraction angiography (DSA). METHODS. One hundred fifty patients with conditions requiring intraarterial digital subtraction angiography were randomly assigned to receive 150 mg I/mL iopromide or either 160 nig I/mL ioversol or 128 mg I/mL iopamidol. Cerebral, aortovisceral, and peripheral arteriography was performed. RESULTS. No significant difference was found in safety, tolerance, and technical efficacy between iopromide and ioversol. Iopamidol had significantly less technical efficacy than iopromide, but there were no significant differences in safety or tolerance between these two agents. CONCLUSIONS. All three contrast media (CM) are useful for cerebral DSA. Although these agents were diagnostically adequate for use during aortovisceral and peripheral DSA, none was able to optimally opacify vessels during these studies in the concentrations administered.
Iopromide
Iopamidol
Digital subtraction angiography
Iohexol
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The aim of the randomized multicentre double-blind study was to establish whether nonionic contrast media differ in tolerability. The controlled comparison was conducted at 4 centres on a total of 798 patients with indication for i.v. DSA and computed tomography. The nonionic contrast media Iopamidol and Iopromide with an iodine content of 300 mg/ml each were studied. The osmolality of both contrast media is virtually identical. Both groups of patients were largely homogeneous in terms of demographic data and case history. The history of allergies was positive in 32.4% of the Iopamidol group and in 32.3% of the Iopromide group. The arithmetic mean of the doses administered to each patients was 148.3 and 149.3 ml, respectively. At all 4 centres there was a higher incidence of adverse events with Iopromide than with Iopamidol. The main differences with regard to pseudo-allergic reactions was the incidence of urticarial reactions, pruritus, nausea, vomiting and coughing. 89 of the 399 patients (22.3%) receiving Iopamidol and 120 of the 399 patients (30.1%) receiving Iopromide experienced pseudo-allergic reactions. The difference between both contrast media is statistically significant (p less than 0.05). There is a 95% certainty that less pseudo-allergic reactions will occur after an Iopamidol injection than after Iopromide. Possible explanations for the differences in tolerability between the two nonionic contrast media with identical osmolality are discussed.
Iopamidol
Iopromide
Tolerability
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Iopromide
Iopamidol
Intravenous urography
Pyelogram
Iodinated contrast media
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Abstract A double blind randomized trial of two non-ionic contrast media—iopamidol and iopromide—was performed on 101 patients undergoing left ventriculography and coronary angiography. Both products performed well in the trial and there were no statistically significant differences in side effects, cardiovascular parameters, blood analysis or film quality between the two products.
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Iopamidol
Conventional angiography
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The comparison of x-ray attenuations of contrast media in different dilutions: An experimental study
Aims: Iodinated contrast materials are used as contrast material in radiologic examinations. There is an intense competition between the contrast media companies in the contrast market in areas such as price, effectivities, and lack of side effects. This experimental study was carried out for comparing the effectiveness of contrast agents. We measured X-ray attenuations of contrast agents because image quality depends on these attenuation amounts. Materials and Methods: Contrast agents are divided into two main groups in iodinated contrast materials; ionic-iodinated contrast agents and nonionic-iodinated contrast agents. Nonionic contrast materials are iopamidol, iohexol, iopromide, iobitridol, and iomeprol. In this study, by using contrast agents in different dilutions, X-ray attenuations were examined in Hounsfield units by using computed tomography. Results: There was no statistically significant difference between the slopes of five commercial forms according to dilutions. Conclusion: From our study, we concluded that iopamidol, iohexol, iopromide, iobitridol, or iomeprol are same in clinical usage.
Iopamidol
Iopromide
Iohexol
Iodinated contrast
Iodinated contrast media
Serial dilution
Diatrizoate Meglumine
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This editorial refers to 'Clopidogrel pre-treatment in stable angina: for all patients .6 h before elective coronary angiography or only for angiographically selected patients a few minutes before PCI?A randomized multicentre trial PRAGUE-8' † by P. Widimsky ´et al., on page 1495Dual antiplatelet therapy is the mainstay of antiplatelet treatment in percutaneous coronary interventions (PCIs) with stent implantation, as well as in acute coronary syndromes (ACS) with and without ST segment elevation. 1 -3 In ACS, dual antiplatelet therapy has been shown to reduce the risk of death and myocardial infarction (MI), both at the initial phase and in the long term.In the setting of stent implantation, dual antiplatelet therapy has been shown to reduce the risk of major adverse cardiac events (MACEs) and stent thrombosis, as compared with various other antithrombotic regimens.Ticlopidine was the first thienopyridine to be used in the setting of stent implantation, but, over time, clopidogrel has proven to be better tolerated and more efficacious. 4owever, clopidogrel is a prodrug, which requires a two-step metabolism in the liver to be transformed into its active metabolite.Its onset of action is quite slow, and the level of inhibition of platelet aggregation (IPA) achieved with the recommended regimen is quite low compared with other compounds. 5,6This implies that if clopidogrel is administered at the time of stent implantation, the level of IPA could be quite low during the critical 3-4 h after the procedure.Two solutions have been proposed to overcome this problem.The first is to administer clopidogrel long before the procedure.This strategy has been shown to be efficacious in three different settings.In the CREDO study, it was shown that better outcome following stent implantation could be achieved if clopidogrel was administered .14h before the procedure. 7In PCI-CURE and CLARITY, pre-treatment with clopidogrel was shown to lead to
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Ticlopidine
Coronary stent
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The liver and kidney tolerance of iopromide 370 in comparison to that of sodium meglumine diatrizoate 370 or iopamidol 370 in doses of 2 ml/kg body weight was examined in two controlled double-blind studies with intravenous digital subtraction angiography on the basis of enzyme assays in serum and urine. In patients with normal kidney function no changes were observed in the levels of the liver enzymes GPT, GOT, and gamma glutamyl transpeptidase (GGT) serum up to 72 hours after injection of iopromide or sodium meglumine diatrizoate. Among the kidney-specific enzymes, the excretion of GGT in urine increased after injection of iopromide and iopamidol. The maximum increase of GGT excretion was, however, statistically significantly lower in the group treated with iopromide than in the iopamidol group. Within 72 hours, the activities had been returned to the initial values in both groups.
Iopromide
Iopamidol
Diatrizoate Meglumine
Diatrizoate
Digital subtraction angiography
Iohexol
Meglumine
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A prospective randomised comparison was undertaken of iopromide and iopamidol in intravenous digital subtraction angiography. This revealed that the two contrast agents produced pictures of similar quality. A slightly increased number of side effects in patients with cardio-pulmonary disease was demonstrated in the investigation and a slightly increased number of side effects after injection of iopamidol.
Iopamidol
Iopromide
Digital subtraction angiography
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