In the Journals

Modulation system reduces contrast media volume without compromising image quality

Roxana Mehran
New data from the AVERT trial demonstrate that use of a manual contrast modulation system during coronary angiography with or without PCI was feasible and safe, with significant reductions in volume of contrast media injected in patients at risk for contrast-induced acute kidney injury, without affecting the quality of angiographic images obtained.

The greatest reduction in contrast media volume was observed in patients undergoing PCI of multiple lesions, compared with diagnostic angiography only, Roxana Mehran, MD, professor of medicine at Icahn School of Medicine at Mount Sinai and associated medical editor of Cardiology Today’s Intervention, and colleagues reported in JACC: Cardiovascular Interventions.

The prospective, randomized, multicenter AVERT trial enrolled 578 patients at 39 centers who had baseline estimated glomerular filtration rate of 20 to 30 ml/min/1.73 m2 or eGR of 30 to 60 ml/min/1.73 m2 and at least two additional risk factors for contrast-induced acute kidney injury. The median age was 72 years and 65% had diabetes. Mean baseline serum creatinine level was 1.6 mg/dL.

Patients undergoing coronary angiography, with or without possible or planned PCI, were randomly assigned to periprocedural hydration plus intraprocedural use of the AVERT system (Osprey Medical; n = 292) or hydration only (n = 286). Forty-two percent of patients underwent PCI; the remainder underwent angiography only.

The AVERT system features an adjustable resistance circuit that reduces the pressure head delivering contrast to the patient.

The hydration plus contrast modulator system protocol resulted in a 15.5% relative reduction in use of contrast media volume overall (85.6 ml vs. 101.3 ml; P = .02). Among patients who underwent PCI, the relative reduction in use of contrast media volume was 22.8% (114 ml vs. 147 ml; P = .001). The maximum reduction in volume was 31% among patients who had two lesions treated and 46% among patients with three lesions treated.

According to the researchers, use of the system did not compromise image quality and resulted in “appropriate” image quality in more than 99% of patients.

The rate of contrast-induced acute kidney injury was about 27% in both groups. Mehran and colleagues noted, however, that “other studies that have tested automatic injection devices for the reduction of contrast media volume and contrast-induced acute kidney injury have also failed to show a clinical benefit despite reducing contrast media volume.”

Thus, the researchers concluded that “future trials are needed to determine whether contrast media volume reduction with the AVERT system provides clinical benefit beyond hydration alone in patients at high risk for contrast-induced acute kidney injury requiring large contrast media volume use (ie, complex PCI).” - by Katie Kalvaitis

Disclosures: The AVERT trial was sponsored by Osprey Medical. Mehran reports she receives institutional research grant support from AstraZeneca, Bristol-Myers Squibb, Lilly/Daiichi-Sankyo and The Medicines Company; is on the advisory board for Janssen (Johnson & Johnson); and receives consulting fees and honoraria from Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, CSL Behring, Janssen (Johnson & Johnson) and Merck. Please see the full study for the other authors’ relevant financial disclosures.

Roxana Mehran
New data from the AVERT trial demonstrate that use of a manual contrast modulation system during coronary angiography with or without PCI was feasible and safe, with significant reductions in volume of contrast media injected in patients at risk for contrast-induced acute kidney injury, without affecting the quality of angiographic images obtained.

The greatest reduction in contrast media volume was observed in patients undergoing PCI of multiple lesions, compared with diagnostic angiography only, Roxana Mehran, MD, professor of medicine at Icahn School of Medicine at Mount Sinai and associated medical editor of Cardiology Today’s Intervention, and colleagues reported in JACC: Cardiovascular Interventions.

The prospective, randomized, multicenter AVERT trial enrolled 578 patients at 39 centers who had baseline estimated glomerular filtration rate of 20 to 30 ml/min/1.73 m2 or eGR of 30 to 60 ml/min/1.73 m2 and at least two additional risk factors for contrast-induced acute kidney injury. The median age was 72 years and 65% had diabetes. Mean baseline serum creatinine level was 1.6 mg/dL.

Patients undergoing coronary angiography, with or without possible or planned PCI, were randomly assigned to periprocedural hydration plus intraprocedural use of the AVERT system (Osprey Medical; n = 292) or hydration only (n = 286). Forty-two percent of patients underwent PCI; the remainder underwent angiography only.

The AVERT system features an adjustable resistance circuit that reduces the pressure head delivering contrast to the patient.

The hydration plus contrast modulator system protocol resulted in a 15.5% relative reduction in use of contrast media volume overall (85.6 ml vs. 101.3 ml; P = .02). Among patients who underwent PCI, the relative reduction in use of contrast media volume was 22.8% (114 ml vs. 147 ml; P = .001). The maximum reduction in volume was 31% among patients who had two lesions treated and 46% among patients with three lesions treated.

According to the researchers, use of the system did not compromise image quality and resulted in “appropriate” image quality in more than 99% of patients.

The rate of contrast-induced acute kidney injury was about 27% in both groups. Mehran and colleagues noted, however, that “other studies that have tested automatic injection devices for the reduction of contrast media volume and contrast-induced acute kidney injury have also failed to show a clinical benefit despite reducing contrast media volume.”

Thus, the researchers concluded that “future trials are needed to determine whether contrast media volume reduction with the AVERT system provides clinical benefit beyond hydration alone in patients at high risk for contrast-induced acute kidney injury requiring large contrast media volume use (ie, complex PCI).” - by Katie Kalvaitis

Disclosures: The AVERT trial was sponsored by Osprey Medical. Mehran reports she receives institutional research grant support from AstraZeneca, Bristol-Myers Squibb, Lilly/Daiichi-Sankyo and The Medicines Company; is on the advisory board for Janssen (Johnson & Johnson); and receives consulting fees and honoraria from Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, CSL Behring, Janssen (Johnson & Johnson) and Merck. Please see the full study for the other authors’ relevant financial disclosures.