1. Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions
- Author
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Nicholas Isom, Michael Pierpoline, Nilay Patel, Matthew Lippmann, Peter Tadros, Matthew Earnest, Tarun Dalia, Kamal Gupta, John Chen, Tyler Buechler, Ashwani Mehta, Bashar S. Amr, Patrick Tobbia, Mark Wiley, and Eric Hockstad
- Subjects
Blood Glucose ,Male ,Cardiac Catheterization ,Time Factors ,medicine.medical_treatment ,Psychological intervention ,Administration, Oral ,Contrast Media ,Blood Pressure ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Risk Assessment ,Drug Hypersensitivity ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Diabetes mellitus ,Diabetes Mellitus ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Antihypertensive Agents ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,Blood pressure ,Anesthesia ,Hypertension ,Angiography ,Administration, Intravenous ,Female ,Steroids ,Hemoglobin ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Mace - Abstract
Objectives Oral steroids are routinely administered in the United States for prophylaxis of iodinated contrast media hypersensitivity (ICMH). We studied the impact of short-term steroid use in diabetic patients with ICMH undergoing nonemergent coronary angiography. Methods We retrospectively analyzed records of diabetic patients with and without ICMH who underwent nonemergent coronary angiography at our center. Primary study endpoint was 30-day major adverse cardiac events (MACE) and secondary endpoints were pre- and postprocedure fasting blood glucose (FBG), highest in hospital blood glucose, pre- and postprocedure systolic blood pressure (SBP), and use of intravenous insulin and antihypertensive medications. Results A total of 88 diabetics with ICMH (study group) and 76 diabetics without ICMH (control group) undergoing angiography were enrolled. Demographics and hemoglobin A1c values were similar in both groups. Preprocedural FBG was significantly higher in the study group. The study group had significantly higher post angiography FBG (239.93 + 96.88 mg/dl vs. 156.6 + 59.88 mg/dl) and greater use of intravenous (IV) insulin (67.27% vs. 32.43%). Further, those who received steroids had significantly higher systolic SBP postprocedure (146.16 + 25.35 mmHg vs. 130.8 + 21.59 mmHg), a higher incidence of severe hypertension and use of IV antihypertensive medications (80.95% vs. 19.05%) periprocedurally. There were no differences in 30-day MACE between groups. Conclusion Short-term steroid use for ICMH results in a significant increase in surrogate markers for adverse clinical events after coronary procedures. Study findings highlight the need for better periprocedural management of these patients and to limit steroid prophylaxis to those with only true ICMH.
- Published
- 2019
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