Nephrotoxicity of iodixanol versus iopamidol in patients with acute coronary syndrome

Objectives: The iso-osmolar contrast agent iodixanol may be associated with fewer contrast-induced acute kidney injuries when compared with low-osmolar contrast agents. The aim of this study is to compare iodixanol and iopamidol in patients with acute coronary syndrome (ACS) who are currently undergoing coronary angiography. Study design: Two hundred and seventy five consecutive patients who presented to a tertiary cardiovascular center with acute non-ST elevation myocardial infarction and underwent coronary angiography as a part of an early invasive strategy were included in the study (mean age 58+-11 years, 79% male). Study participants were administered either iodixanol (n=45) or iopamidol (n=230) and the groups were compared for the highest creatinine levels, the absolute and percent change in creatinine levels, and for the development of contrast induced nephropathy within 72 hours of the procedure. Results: Baseline demographic and clinical characteristics of the patients were similar between the two groups. There were no differences in the preprocedural serum creatinine (iopamidol 1.10+-0.54 mg/dl, iodixanol 1.09+-0.24 mg/dl, p=0.680), glomerular filtration rate (iopamidol 89+-35 ml/dk/1.73 m2, iodixanol 89+-26 ml/dk/1.73 m2, p=0.934), or contrast volume used during the procedure (iopamidol 180+-80 ml vs. iodixanol 166+-73 ml, p=0.226) between the groups. The absolute change in serum creatinine after the procedure (iopamidol 0.136+-0.346 mg/dl, iodixanol 0.072+-0.070 mg/dl, p=0.118) and the percent change in serum creatinine after the procedure (iopamidol 12.1+-29.6%, iodixanol 6.8+-6.9%, p=0.075) were not statistically significant between the two groups. Contrast induced nephropathy developed 10% (95% confidence interval [CI] 6–14%) in iopamidol group whereas it was 2.2% (95% CI -2-7%) in iodixanol group (p=0.144). Conclusion: Iodixanol was not superior to iopamidol regarding contrast induced acute kidney injury after coronary angiography in an unselected general patient population with ACS.