Background: Adverse reactions to intravascular high osmolar contrast media occur in 5% to 12% of patients compared with a 1% to 3% incidence in those receiving low osmolar contrast media. Reactions to contrast media may include anaphylactoid, or pseudoallergic reactions; chemotoxic reactions; osmotoxic reactions; and vasovagal reactions. Severe reactions occur in <0.004% of procedures with ionic contrast media and in 0.001 % of procedures with nonionic radioopaque contrast media. This study was done to evaluate the effect of pre-heating of radiocontrast materials (RCM) in the incidence of contrast-related adverse events, such as contrast-induced nephropathy, periprocedural Myocardial Infarction (MI) and intraprocedural coronary spasm in patients undergoing coronary angiogram.
Methods: This is a randomized controlled trial done at the cardiac catheterization laboratory of the Philippine Heart Center from April to December 2008. The subjects were randomized by block randomization into two groups: those who received room temperature RCM and those who received preheated RCM using contrast material warmer. Patients underwent routine coronary angiography using standard methods. Outcomes in terms of occurrence of adverse reactions, myocardial infarction, intraprocedural coronary spasm and contrast -induced
nephropathy were monitored during and after the procedure.
Results: There are a total of 497 patients enrolled in the study with mean age of 53 years old in both groups. Outcomes measured are presence of arbitrary symptoms, contrast induced nephropathy, myocardial infarction and coronary spasm. It appears that there is no significant difference in terms of arbitrary symptoms, coronary spasm and nephropathy in both groups. No incidence of myocardial infarction seen.
Conclusion: Over all, there was a trend towards a lesser incidence of contrast induced nephropathy (CIN), coronary spasm and arbitrary symptoms in the pre-heated group (treatment group) compared to the room-air group. The outcome all in all is not statistically significant.