Acute and subacute stent occlusion; risk-reduction by ionic contrast media

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Abstract
Aims Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (≤72h) and subacute (≤30 days) stent thrombosis has not been investigated. Methods Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention. Results Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1·3% in group I vs 0·3% in group II, P=0·001; subacute stent occlusion: 2·4% in group I vs 0·7% in group II, P=0·001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22·9% vs 16·3%,P =0·001). Conclusions Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated.

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