A comparison of nonionic, low-osmolality radiocontrast agents with ionic, high-osmolality agents during cardiac catheterization

Article Abstract:

Non-ionic, low-osmolality contrast dyes should be used instead of ionic, high-osmolality dyes to image coronary arteries in patients with severe heart disease or unstable angina (chest pain). Of 1,490 patients undergoing cardiac catheterization, 737 were given high-osmolality dye and 753 were given low-osmolality dye. Twenty-nine percent of the high-osmolality group had an adverse reaction, but only nine percent of the low-osmolality group had an adverse reaction. Symptoms were severe or lasted longer in 2.9% of the high-osmolality group compared to 0.8% of the low-osmolality group. Twenty-two of the 27 patients with severe reactions had advanced heart disease or unstable angina. The cost of dye in the high-osmolality group was $16,333 compared to $87,843 for the same number of patients in the low-osmolality group. To reduce costs, low-osmolality dye should be used only in patients with serious heart disease or angina, and high-osmolality dye in patients who have a lower risk of adverse reactions.

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Magnetic resonance coronary angiography - assessing an emerging technology

Article Abstract:

Magnetic resonance imaging (MRI) coronary angiography may be an effective non-invasive method for diagnosis of coronary artery disease. A research study found that MRI coronary angiography detected narrowing of the major coronary arteries in 39 patients. Comparison of MRI coronary angiography to conventional angiography found that it was both a sensitive and specific method. MRI coronary angiography may over-diagnose coronary artery disease in the right coronary artery and under-diagnose coronary artery disease in the left circumflex artery. The high sensitivity and specificity of MRI coronary angiography may have been partially influenced by the group of patients who underwent the procedure. MRI coronary angiography may be useful for both the diagnosis of coronary artery disease and for following the progression of the disease. This technique needs further improvements to increase its usefulness for the diagnosis and treatment of coronary artery disease.

Editorial, Innovations, Magnetic resonance imaging, Coronary arteries

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Safety and cost effectiveness of high-osmolality as compared with low-osmolality contrast material in patients undergoing cardiac angiography

Article Abstract:

The use of low-osmolality dyes in cardiac angiography can reduce the incidence of adverse reactions, but because of their greater cost, their use should be limited to those patients at greatest risk of having an adverse reaction. A survey of 505 patients undergoing cardiac angiography found that 24% had a minor or mild reaction, 10% had a moderate reaction and 2% had a severe reaction. All of the severe reactions and 85% of the moderate ones occurred in patients older than 60 years or with unstable angina. These patients were 3.5 times more likely to have a moderate reaction. The 253 patients who received high-osmolality dyes were three to four times more likely to have mild or moderate reactions than 252 patients given low-osmolality dyes. But they were no more likely to have a severe reaction than the patients given low-osmolality dyes.

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