Comparison of low osmolality ionic (ioxaglate) versus nonionic (iopamidol) contrast media in cardiac angiography

Abstract

A double-blind randomized study was performed in 60 patients to compare the electrocardiographic and hemodynamic changes induced during cardiac angiography by 2 contrast media with relatively low osmolality. Ioxaglate meglumine sodium, an ionic dimer contrast medium, was compared with iopamidol, a nonionic compound. Of the 30 patients who received ioxaglate, 13 (43%) experienced a mild to moderate adverse reaction to the contrast media, while only 2 of the 30 patients (7%) in the iopamidol group had similar side effects (p less than 0.005). Significant prolongations of the QT intervals occurred with the ioxaglate injections. The QT intervals increased from 402 +/- 46 to 442 +/- 59 ms (p less than 0.001) with the right coronary artery injection and similar changes were observed after the left coronary artery injection and left ventriculography. Significant ST-segment and T-wave amplitude changes also occurred in the ioxaglate group. With iopamidol injections, there were no significant changes in any of these parameters. After the left ventriculogram, there were similar decreases in the systolic arterial pressures in both groups (-14 +/- 10 mm Hg with ioxaglate and -21 +/- 9 mm Hg with iopamidol). The left ventricular end-diastolic pressures increased after the ventriculogram in both groups (5 +/- 5 vs 2 +/- 3 mm Hg with ioxaglate and iopamidol, respectively, 60 seconds after the injection). This report demonstrates that mild to moderate adverse reactions, QT-interval prolongations, ST and T-wave changes were significantly greater during coronary angiography with ioxaglate when compared with iopamidol.(ABSTRACT TRUNCATED AT 250 WORDS)