{"id":7496,"date":"2025-06-25T17:22:43","date_gmt":"2025-06-25T14:22:43","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=7496"},"modified":"2025-06-25T17:22:43","modified_gmt":"2025-06-25T14:22:43","slug":"scientific-summary-minimizing-contrast-in-pci-to-prevent-aki-trends-and-practical-strategies","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/scientific-summary-minimizing-contrast-in-pci-to-prevent-aki-trends-and-practical-strategies\/","title":{"rendered":"Scientific Summary: Minimizing Contrast in PCI to Prevent AKI \u2013 Trends and Practical Strategies"},"content":{"rendered":"
Scientific Summary: Minimizing Contrast in PCI to Prevent AKI \u2013 Trends and Practical Strategies<\/div>\n
<\/div>\n
(JACC, JACC,May 2025 Volume 85, Issue 17) Highlighted in 4 June 2025.<\/div>\n
<\/div>\n
1. Clinical Context<\/div>\n
\u2022 Contrast-induced acute kidney injury (AKI) is a serious complication of percutaneous coronary intervention (PCI).<\/span><\/div>\n
\u2022 Two recent sources\u2014ACC CathPCI Registry data and a procedural review\u2014highlight the need for structured contrast-reduction strategies.<\/span><\/div>\n
<\/div>\n
2. National Trends (ACC Registry Analysis)<\/div>\n
\u2022 Data from over 3 million PCI cases (2018\u20132022) at 1,786 U.S. hospitals showed:<\/span><\/div>\n
\u2022 Mean contrast volume declined from 168.1 mL to 71.2 mL.<\/span><\/div>\n
\u2022 High-risk patients received lower contrast volumes overall.<\/span><\/div>\n
\u2022 Yet, 37.5% of operators showed no improvement, and 9.2% increased usage.<\/span><\/div>\n
\u2022 Conclusion: Contrast reduction is improving, but implementation remains inconsistent.<\/span><\/div>\n
<\/div>\n
3. Practical Contrast Reduction Strategies<\/div>\n
<\/div>\n
A. Imaging-Based Approaches<\/div>\n
\u2022 Use of IVUS and OCT to guide PCI without contrast (e.g., MOZART trial)<\/span><\/div>\n
<\/div>\n
B. Pre-Procedural Planning<\/div>\n
\u2022 Leverage prior angiograms and dynamic coronary roadmapping<\/span><\/div>\n
<\/div>\n
C. Technical Measures<\/div>\n
\u2022 Diluted contrast (1:1 saline), low-volume syringes, avoid side-hole catheters<\/span><\/div>\n
<\/div>\n
D. Monitoring and Feedback<\/div>\n
\u2022 Tracking contrast-to-GFR ratios is an effective strategy to reduce AKI risk in PCI.<\/span><\/div>\n
The Contrast-to-GFR Ratio is calculated using the formula:<\/div>\n
Contrast Volume (mL) \u00f7 eGFR (mL\/min\/1.73 m\u00b2)<\/div>\n
<\/div>\n
Example:<\/div>\n
If 100 mL of contrast is used in a patient with eGFR of 40 \u2192 the ratio is 2.5<\/div>\n
<\/div>\n
Interpretation:<\/div>\n
\u2022 <2.0 = low risk<\/span><\/div>\n
\u2022 2.0\u20133.7 = moderate risk (use caution)<\/span><\/div>\n
\u2022 >3.7 = high risk \u2014 studies recommend avoiding this if possible<\/span><\/div>\n
<\/div>\n
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<\/div>\n
<\/div>\n
E. Contrast-Reducing Devices<\/div>\n
\u2022 Devices like DyeVert\u2122 reduce unnecessary contrast exposure<\/span><\/div>\n
<\/div>\n
F. Adjunctive Measures<\/div>\n
\u2022 Hydration:<\/span><\/div>\n
Hydration is a cornerstone strategy to prevent AKI. IV fluids saline\u00a0 (1\u20131.5 mL\/kg\/h) are recommended before, during, and after PCI, typically starting 1\u20133 hours before and continuing up to 4-12 hours post-procedure.<\/div>\n
In heart failure patients, LVEDP-guided hydration offers a safer, tailored approach.<\/div>\n
For low-risk elective patients, oral hydration may suffice.<\/div>\n
<\/div>\n
4. Recommendations<\/div>\n
\u2022 Hospitals and PCI centers should implement multimodal, evidence-based strategies.<\/span><\/div>\n
\u2022 Regular feedback, education, and technology integration are key to achieving safer PCI with minimal renal complications.<\/span><\/div>\n
<\/div>\n
5. References<\/div>\n
\u2022 Ikemura N, et al. Trends in Contrast Use in PCI: ACC CathPCI Registry. JACC, May 2025. \ud83d\udd17 JACC Link<\/span><\/div>\n
\u2022 Khatri J, et al. Ultra-Low Contrast PCI Techniques. Interventional Cardiology Review, 2023.<\/span><\/div>\n
Conclusion:<\/div>\n
The convergence of registry trends, AI risk tools, and procedural best practices\u2014including personalized hydration\u2014marks a transformative shift in PCI safety and renal protection.<\/div>\n
<\/div>\n
https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2025.03.528<\/a><\/div>\n
https:\/\/www.frontiersin.org\/journals\/medicine\/articles\/10.3389\/fmed.2021.701062\/full?utm_source=chatgpt.com<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

Scientific Summary: Minimizing Contrast in PCI to Prevent AKI \u2013 Trends and Practical Strategies (JACC, JACC,May 2025 Volume 85, Issue 17) Highlighted in 4 June 2025. 1. Clinical Context \u2022 Contrast-induced acute kidney injury (AKI) is a serious complication of percutaneous coronary intervention (PCI). \u2022 Two recent sources\u2014ACC CathPCI Registry data and a procedural review\u2014highlight […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7496","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7496","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=7496"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7496\/revisions"}],"predecessor-version":[{"id":7501,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7496\/revisions\/7501"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=7496"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=7496"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=7496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}