Percutaneous coronary intervention during the shortage of iodinated contrast.

Abstract

Objectives: A recent coronavirus-related factory shutdown led to a global shortage of iodinated contrast. The authors evaluated how the contrast shortage impacted percutaneous coronary interventions (PCI).

Methods: Using a statewide database incorporating CathPCI registry data from 19 hospitals, the authors evaluated 2 time periods: pre-shortage (May 1, 2021 - April 30, 2022) and during the shortage (May 1, 2022 - October 31, 2022). They compared procedure volumes, patient and procedure characteristics, and short-term outcomes, including acute kidney injury (AKI). Of primary interest was the difference in contrast volume per PCI and the incidence of AKI between periods.

Results: There were 8980 patients treated pre-shortage and 4046 during the shortage. Procedure volumes per hospital remained similar, as did patient characteristics. Multivessel procedures declined during the shortage (45.3% vs 42.8%, P = .007). There was a significant decline in contrast per procedure (149.9 ± 68.1 mL to 137.5 ± 62.4 mL per case, P less than .0001) that began at the start of the shortage and continued throughout. There were no differences in patient outcomes, including AKI (7.9% vs 7.4%, P = .40), between study periods. When limited to patients at increased risk of AKI, there remained no difference in AKI between the study periods, despite a similar decrease in contrast volume in that cohort. Multivariable analysis showed a strong correlation between baseline risk of AKI and subsequent AKI (P less than .0001), but no impact of procedure characteristics or time period.

Conclusions: The global shortage of iodinated contrast led to a significant decline in contrast use during PCI, with no impact on patient outcomes.