Impact of automated contrast injector systems on contrast use and contrast-associated complications in patients undergoing percutaneous coronary interventions.

OBJECTIVES: The purpose of this study was to assess the impact of manual versus automated contrast injection on renal complications in patients undergoing percutaneous coronary intervention (PCI).
BACKGROUND: Contrast volume is a major modifiable risk factor for contrast-induced nephropathy (CIN). Automated contrast injector systems (ACIS) are believed to be associated with a reduction in the total volume of contrast media use.
METHODS: We compared the outcome of 60,884 patients who underwent PCI at 28 hospitals in Michigan in 2008 to 2009 and assessed the outcome of those treated at hospitals that did not use ACIS (n = 24) and compared them with those that used ACIS (n = 4). Propensity matching was used to adjust for baseline differences.
RESULTS: The use of ACIS was associated with a statistically significant albeit clinically small difference in the average volume of contrast media use (mean 199 ± 84 ml vs. mean 204 ± 82 ml, p < 0.0001) with no difference in proportion of patients exceeding contrast volume/calculated creatinine clearance ratio of 3 (28.4% vs. 29.1%, p = 0.19). There was no difference in the incidence of CIN (3.11% vs. 3.42%, p = 0.15) or new need for dialysis (0.30% vs. 0.33%, p = 0.54), and these differences remained nonsignificant in propensity matched analysis. In fully adjusted, multivariate logistic analysis, patients treated with ACIS remained as likely to develop CIN (odds ratio: 0.96, 95% confidence interval: 0.83 to 1.11, p = 0.56) or new need for dialysis (odds ratio: 0.83, 95% confidence interval: 0.54 to 1.28, p = 0.40).
CONCLUSIONS: Compared with hospitals using manual injection, institutions having ACIS used slightly less amount of contrast with no reduction in CIN. Use of ACIS is unlikely to impact contrast-induced renal complications in patients undergoing PCI.