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Meta-Analysis
. 2011 May 24:11:12.
doi: 10.1186/1471-2342-11-12.

Patient discomfort associated with the use of intra-arterial iodinated contrast media: a meta-analysis of comparative randomized controlled trials

Peter A McCullough  1 , Patrizio Capasso
Affiliations
Meta-Analysis

Patient discomfort associated with the use of intra-arterial iodinated contrast media: a meta-analysis of comparative randomized controlled trials

Peter A McCullough et al. BMC Med Imaging. .

Abstract

Background: Discomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with iso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM).

Methods: A review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed to compare rates of discomfort associated with the use of the IOCM (iodixanol) vs. various LOCM agents in head-to-head RCTs. All trials with a Jadad score ≥2 that reported patient discomfort data following intra-arterial administration of CM were reviewed, coded, and extracted.

Results: A total of 22 RCTs (n = 8087) were included. Overall discomfort (regardless of severity) was significantly different between patients receiving IOCM and various LOCMs (risk difference [RD] -0.049; 95% confidence interval [CI]: -0.076, -0.021; p = 0.001). IOCM was favored over all LOCMs combined with a summary RD value of -0.188 (95% CI: -0.265, -0.112; p < 0.001) for incidence of pain, regardless of severity. A greater reduction in the magnitude of pain was observed with IOCM (iodixanol), particularly with selective limb and carotid/intracerebral procedures. Similarly, the meta-analysis of warmth sensation, regardless of severity, favored IOCM over LOCMs with an RD of -0.043 (95% CI: -0.074, -0.011; p = 0.008). A positive linear relationship was observed between the discomfort effect size and age and a negative relationship with increasing proportion of women. The opposite trends were observed with warmth sensation.

Conclusions: IOCM was associated with less frequent and severe patient discomfort during intra-arterial administration. These data support differences in osmolality as a possible determinant of CM discomfort.

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Figures

Figure 1
Figure 1
Flow chart outlining literature search and study selection strategy.
Figure 2
Figure 2
A. Incidence of any discomfort (regardless of severity) associated with CM injections organized by region. B. Meta-analysis of incidence of CM-associated discomfort (regardless of severity) - IOCM (iodixanol) vs. LOCMs.
Figure 3
Figure 3
A. Incidence of CM-associated pain based on severity. B. Incidence of any pain (regardless of severity) associated with CM injection. C. Meta-analysis of incidence of CM-associated pain (regardless of severity) - IOCM (iodixanol) vs. LOCMs.
Figure 4
Figure 4
Meta-analysis of incidence of CM-associated warmth regardless of severity - IOCM (iodixanol) vs. all LOCMs (upper panel); Meta-analysis of incidence of CM-associated warmth, moderate or severe vs none or mild severity - All LOCMs (lower panel).
Figure 5
Figure 5
Bivariate fixed-effects meta-regression analysis with continuous covariates. The open circles in each panel represent the primary trials. The area of each circle is directly proportional to the relative weight of that study. The solid line is the regression line. (Panels A and B represent the incidence of CM-associated pain with severity; Panels C and D represent CM-associated warmth with severity).
See this image and copyright information in PMC

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