Comparison of ionic and low-osmolar contrast media during cardiac catheterization

The use of nonionic contrast agents during cardiac catheterization decreases the incidence of both major and minor cardiovascular complications when compared with ionic contrast. Hemodynamic and electrophysiologic effects are less profound especially in patients who have severe coronary artery disease or left ventricular dysfunction. Sparse data exist comparing ionic and nonionic contrast in patients undergoing percutaneous transluminal coronary angioplasty. No clinical evidence suggests that nonionic contrast agents are less nephrotoxic than ionic contrast though patients with significant baseline renal dysfunction (creatinine > 3.0) might benefit. The incidence of thrombotic events appears to be similar for both types of agents. Finally, the risk reduction of cardiovascular events must be weighed against markedly higher costs.