Latest American College of Cardiology/American Heart
Association guidelines on acute coronary syndrome recommend
isosmolar contrast media in chronic kidney disease patients
The American College of Cardiology (ACC) and the American Heart Association (AHA) have published new guidelines on the management of patients with acute coronary syndromes, which cover the use of coronary angiography in these patients(Ref: 1). The guidelines highlight the use of an 'invasive' strategy for managing many patients presenting with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI), according to which coronary angiography is undertaken, typically within 4–24 hours after admission.
The recommendation is based on Level A evidence, the highest level of certainty, indicating that there is sufficient supporting evidence from randomised trials and meta-analyses and it is a Class 1 recommendation, meaning that isosmolar contrast should be used since the benefit considerably exceeds any risk.
The use of coronary angiography inevitably exposes patients to the possible risk of acute kidney injury associated with the use of iodinated contrast media (contrast induced nephropathy; CIN). It is recognised that this is a particular risk in patients with chronic kidney disease (CKD) with or without diabetes mellitus.
