Impact of Ionic and Non-ionic Contrast Medi on Post-PTC Ischemic Complications: Results from the EPIC Trial

Previous studies have demonstrated greater thrombogenic properties and higher rates of post-PTC ischemic complications with use of non-ionic (NI) compared to ionic (I) contrast media. To assess the role of I vs NI contrast medi on thrombus formation and ischemic complications, we prospectively evaluated the post-PTC outcome of 1,930 patients who were enrolled in the EPIC trial. Patients were enrolled if presenting with acute MI (≤7 days), unstable angina, or had high risk angiographic characteristics. Patients received aspirin (325 mg), procedural heparin, and either placebo infusion (n = 637) or glycoprotein IIB/III receptor antibody, c7E3Fab (n = 1293). I and NI were used in 257 and 380 patients receiving placebo and in 505 and 708 patients receiving c7E3Fab, respectively. More patients receiving NI were enrolled with acute MI (3.5% vs 1.4%), and more patients receiving I had unstable angin (26.1% vs 22.4%). Other baseline and procedural characteristics were similar between patient groups. After controlling for c7E3Fab randomization by logistic regression, ionic contrast agents were associated with lower probability of Q-wave MI (odds ratio: 0.32; P = 0.012) and death (odds ratio: 0.27; P = 0.016). These preliminary dat suggest that the selection of ionic contrast medi during PTC should strongly be considered.