Overconsumption of Contrast Media in Percutaneous Coronary Intervention: Focusing on Cost and Acute Kidney Injury

Irrational use of medicines is a major problem worldwide. Since iodixanol (Visipaque®) was categorized in Category I based on the ABC-VED analysis in our hospital, we evaluated the amount of visipaque use and estimated the incremental cost based on the Maximum Contrast Dose (MCD) following irrational use of contrast media. This retrospective study was conducted on ۱۰۰ admitted patients aged ۱۸ to ۸۰ years old undergoing elective Percutaneous Coronary Intervention (PCI) who received visipaque during February ۲۰۱۶ to January ۲۰۱۷. All of the patients’ information was collected from medical records and Hospital Information System (HIS). MCD was calculated by using the formula proposed by Cigarroa and colleagues: MCD (mL) =۵× body weight (kg)/ Serum Creatinine (SCr) (mg/dl). The amount of contrast media administered ranged from ۲۰۰ to ۶۰۰ mL (mean, ۳۴۸ mL ± ۸۰). ۵۷ % of patients received the visipaque more than MCD. Only ۲۵ patients were evaluated SCr after PCI and in ۱۱ (۴۴%) of these patients SCr increased and ۳ (۱۲%) patients developed CI-AKI. Consumption of the contrast media was ۲ to ۳ times more than previous studies which could be the cause of acute kidney injury besides the extra cost. In our study about six liters more of contrast agent was used which is more than standard values with a cost of approximately ۲,۰۰۰ for ۱۰۰ patients. Therefore, in order to reduce costs and complications, appropriate clinical protocol of contrast media, more supervision on medical residents and contrast infusion pumps, as well as a periodic evaluation study are highly recommended.

Keywords:

Contrast media , Irrational use , Visipaque , Cost , Drug utilization reviews