Introduction: Several clinical studies and meta-analyses have demonstrated lower incidence of adverse renal and cardiovascular outcomes associated with the use of iso-osmolar contrast media (IOCM) than low-osmolar contrast media (LOCM) in patients with variable risk profiles undergoing intra-arterial interventional procedures. However, the association of contrast-type and major adverse renal and cardiovascular events (MARCE) has not been studied via comprehensive and robust real-world data analyses in patients with comorbid conditions considered at risk for post-procedural acute kidney injury (AKI). The objective of this study was therefore to retrospectively assess the MARCE rates comparing IOCM with LOCM in at-risk patients receiving iodinated intra-arterial contrast media using a real-world inpatient data source. Methods: Patients who underwent a diagnostic or treatment procedure with intra-arterial IOCM or LOCM administration were identified using the Premier Healthcare Database. Patient subgroups including those with diabetes, heart failure, chronic kidney disease (CKD) stages 1–4, CKD 3–4, or diagnosis of chronic total occlusion (CTO) were formed. Subgroups with combinations of diabetes and CKD 3–4 with and without CTO were also investigated. We compared the primary endpoint of MARCE (composite of AKI, AKI requiring dialysis, acute myocardial infarction, stroke/transient ischemic attack, stent occlusion/thrombosis, or death) after IOCM versus LOCM administration via adjusted multivariable regression analyses. Results: A total of 536,013 inpatient visits met the primary inclusion and exclusion criteria (IOCM = 133,192; LOCM = 402,821). After multivariable modeling, the use of IOCM was associated with a significantly lower incidence of MARCE than LOCM in patients with CKD 1–4, CKD 3–4, diabetes, or heart failure, with greatest absolute risk reduction (ARR) of 2.4% (p #x3c; 0.0001) in CKD 3–4 patients (relative risk reduction [RRR] = 13.8%, number needed to treat [NNT] = 43). Additionally, ARR associated with IOCM increased to 3.5% (p #x3c; 0.0001) in patients with combined comorbidities of diabetes and CKD 3–4 (RRR = 19.1%, NNT = 29). Statistically significant risk reduction was also found for the use of IOCM among patients who underwent revascularization for CTO (ARR = 1.6% [p #x3c; 0.0001], RRR = 22.3%, NNT = 62). Conclusion: Intra-arterial administration using IOCM in at-risk patients is associated with lower rates of MARCE than the use of LOCM. This difference is especially apparent in patients with a combination of CKD 3–4 and diabetes and in patients with CTO, providing real-world data validation with meaningful NNT in favor of IOCM.
Cardiorenal Med

中文翻译：

---

合并症住院患者动脉内造影剂给药后的主要不良肾脏和心血管事件

简介：几项临床研究和荟萃分析表明，对于风险状况不同的患者，使用等渗造影剂 (IOCM) 与使用等渗造影剂 (IOCM) 相关的肾脏和心血管不良结局发生率低于低渗造影剂 (LOCM)。动脉介入手术。然而，尚未通过全面而可靠的真实世界数据分析对被认为有术后急性肾损伤 (AKI) 风险的合并症患者进行对比剂类型与主要不良肾脏和心血管事件 (MARCE) 之间的关联进行研究。因此，本研究的目的是使用真实世界的住院患者数据源，回顾性评估在接受碘化动脉内造影剂的高危患者中比较 IOCM 和 LOCM 的 MARCE 率。方法：使用 Premier Healthcare 数据库确定接受动脉内 IOCM 或 LOCM 给药的诊断或治疗程序的患者。形成了包括糖尿病、心力衰竭、慢性肾病 (CKD) 1-4 期、CKD 3-4 或慢性完全闭塞 (CTO) 诊断的患者亚组。还研究了有和没有 CTO 的糖尿病和 CKD 3-4 组合亚组。我们通过调整后的多变量回归分析比较了 IOCM 与 LOCM 给药后 MARCE（AKI、需要透析的 AKI、急性心肌梗死、中风/短暂性脑缺血发作、支架闭塞/血栓形成或死亡的复合物）的主要终点。结果：共有 536,013 名住院患者符合主要纳入和排除标准（IOCM = 133,192；LOCM = 402,821）。多变量建模后，在 CKD 1-4、CKD 3-4、糖尿病或心力衰竭患者中，使用 IOCM 的 MARCE 发生率显着低于 LOCM，最大绝对风险降低 (ARR) 为 2.4%。p #x3c; 0.0001) 在 CKD 3-4 患者中（相对风险降低 [RRR] = 13.8%，需要治疗的人数 [NNT] = 43）。此外，在合并糖尿病和 CKD 3-4 期合并症的患者中，与 IOCM 相关的 ARR 增加至 3.5%（p #x3c；0.0001）（RRR = 19.1%，NNT = 29）。在接受 CTO 血运重建的患者中，使用 IOCM 也发现了统计学上显着的风险降低（ARR = 1.6% [ p#x3c; 0.0001]，RRR = 22.3%，NNT = 62）。结论：与使用 LOCM 相比，在有风险的患者中使用 IOCM 进行动脉内给药与较低的 MARCE 发生率相关。这种差异在 CKD 3-4 合并糖尿病的患者和 CTO 患者中尤为明显，通过有意义的 NNT 提供真实世界的数据验证有利于 IOCM。
心肾医学