ADVERSE-EFFECTS OF CALCIUM-BINDING CONTRAST AGENTS IN DIAGNOSTIC CARDIAC ANGIOGRAPHY - A COMPARISON BETWEEN FORMULATIONS WITH AND WITHOUT CALCIUM-BINDING ADDITIVES

RATIONALE AND OBJECTIVES. The authors compared complications and hemodynamic and electrophysiologic effects of two formulations of diatrizoate, one with additives that bind calcium and one without, in diagnostic cardiac angiography. METHODS. Two hundred twenty-three consecutive low-risk patients alternately received Hypaque 76 (group 1, little calcium binding effect), and MD 76 (group 2, significant calcium binding), Electrocardiographic and hemodynamic changes related to coronary angiography and left ventriculography were measured, and complications requiring treatment were recorded. RESULTS. There were more complications in patients in group 2 than in group 1 (18 versus 8, P = 0.04), Arterial pressure fell more, the QT interval increased more, and the heart rate fell more in group 2 after coronary angiography. CONCLUSIONS. Formulations of diatrizoate that minimize calcium binding are advocated for cardiac angiography when using high osmolality contrast media, The more detrimental effects that calcium binding has on myocardial function and cardiac conduction may lead to the higher incidence of complications.