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Randomized Controlled Trial
. 2022 Sep-Oct;74(5):363-368.
doi: 10.1016/j.ihj.2022.08.004. Epub 2022 Aug 22.

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Abhinav Shrivastava  1 , Ranjit Kumar Nath  2 , Himansu Sekhar Mahapatra  3 , Bhagya Narayan Pandit  2 , Ajay Raj  2 , Ajay Kumar Sharma  2 , Tarun Kumar  2 , Dheerendra Kuber  2 , Puneet Aggarwal  2
Affiliations
Randomized Controlled Trial

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Abhinav Shrivastava et al. Indian Heart J. 2022 Sep-Oct.

Abstract

Objectives: This prospective, randomized study assessed short-term outcomes and safety of ultra-low contrast percutaneous coronary intervention(ULC-PCI) vs conventional PCI in high risk for contrast induced acute kidney injury(CI-AKI) patients presenting with acute coronary syndrome(ACS).

Background: Patients at an increased risk of developing CI-AKI can be identified prior to PCI based on their pre-procedural risk scores. ULC-PCI is a novel contrast conservation strategy in such high risk patients for prevention of CI-AKI.

Methods: 82 patients undergoing PCI for ACS were enrolled having estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73 m2 and moderate to very high pre-procedural risk of developing CI-AKI as calculated by Maioli risk calculator. They were randomized into two groups of 41 patients each of ULC-PCI (contrast volume ≤ patient's eGFR) and conventional PCI (contrast volume ≤ 3xpatient's eGFR). Primary end point was development of CI-AKI.

Results: Baseline clinical and angiographic characteristics were similar between groups. Primary outcome of CI-AKI occurred more in patients of the conventional PCI group [7 (17.1%)] than in the ULC PCI group [(0 patients), p = 0.012]. Contrast volume (41.02 (±9.8) ml vs 112.54 (±25.18) ml; P < 0.0001) was markedly lower in the ULC-PCI group. No significant difference in secondary safety outcomes between two study arms at 30 days. IVUS was used in 17% patients in ULC PCI.

Conclusion: ULC-PCI in patients with increased risk of developing CI-AKI is feasible, appears safe, and has the potential to decrease the incidence of CI-AKI specially in resource limited setting such as ours where coronary imaging by IVUS is not possible in every patient.

Keywords: Acute coronary syndrome; Contrast induced acute kidney injury; Contrast induced nephropathy; IVUS; Percutaneous coronary intervention; Ultra-low contrast PCI.

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