Scientific Summary: Minimizing Contrast in PCI to Prevent AKI – Trends and Practical Strategies
Scientific Summary: Minimizing Contrast in PCI to Prevent AKI – Trends and Practical Strategies
(JACC, JACC,May 2025 Volume 85, Issue 17) Highlighted in 4 June 2025.
1. Clinical Context
• Contrast-induced acute kidney injury (AKI) is a serious complication of percutaneous coronary intervention (PCI).
• Two recent sources—ACC CathPCI Registry data and a procedural review—highlight the need for structured contrast-reduction strategies.
2. National Trends (ACC Registry Analysis)
• Data from over 3 million PCI cases (2018–2022) at 1,786 U.S. hospitals showed:
• Mean contrast volume declined from 168.1 mL to 71.2 mL.
• High-risk patients received lower contrast volumes overall.
• Yet, 37.5% of operators showed no improvement, and 9.2% increased usage.
• Conclusion: Contrast reduction is improving, but implementation remains inconsistent.
3. Practical Contrast Reduction Strategies
A. Imaging-Based Approaches
• Use of IVUS and OCT to guide PCI without contrast (e.g., MOZART trial)
B. Pre-Procedural Planning
• Leverage prior angiograms and dynamic coronary roadmapping
C. Technical Measures
• Diluted contrast (1:1 saline), low-volume syringes, avoid side-hole catheters
D. Monitoring and Feedback
• Tracking contrast-to-GFR ratios is an effective strategy to reduce AKI risk in PCI.
The Contrast-to-GFR Ratio is calculated using the formula:
Contrast Volume (mL) ÷ eGFR (mL/min/1.73 m²)
Example:
If 100 mL of contrast is used in a patient with eGFR of 40 → the ratio is 2.5
Interpretation:
• <2.0 = low risk
• 2.0–3.7 = moderate risk (use caution)
• >3.7 = high risk — studies recommend avoiding this if possible
Providing operator-specific feedback on these ratios helps optimize clinical practice and enhance patient safety. Monitor contrast-to-GFR ratios and provide operator-specific feedback
E. Contrast-Reducing Devices
• Devices like DyeVert™ reduce unnecessary contrast exposure
F. Adjunctive Measures
• Hydration:
Hydration is a cornerstone strategy to prevent AKI. IV fluids saline (1–1.5 mL/kg/h) are recommended before, during, and after PCI, typically starting 1–3 hours before and continuing up to 4-12 hours post-procedure.
In heart failure patients, LVEDP-guided hydration offers a safer, tailored approach.
For low-risk elective patients, oral hydration may suffice.
4. Recommendations
• Hospitals and PCI centers should implement multimodal, evidence-based strategies.
• Regular feedback, education, and technology integration are key to achieving safer PCI with minimal renal complications.
5. References
• Ikemura N, et al. Trends in Contrast Use in PCI: ACC CathPCI Registry. JACC, May 2025. 🔗 JACC Link
• Khatri J, et al. Ultra-Low Contrast PCI Techniques. Interventional Cardiology Review, 2023.
Conclusion:
The convergence of registry trends, AI risk tools, and procedural best practices—including personalized hydration—marks a transformative shift in PCI safety and renal protection.