There was a consistent yet modest decline in contrast volume used during PCI between 2018 and 2022, with notably less contrast in patients at high risk of acute kidney injury (AKI) and significant variation at the physician level, according to a brief report published May 5 in JACC.

Using data from ACC's CathPCI Registry, Nobuhiro Ikemura, MD, PhD, et al., included 3,126,559 patients (mean age 66.8 years, 70% men, 40% elective procedures) from 1,786 sites who underwent PCI between April 2018 and December 2022. "Given the frequency of AKI after PCI and the priority of reducing this risk, it is critical to understand current practice patterns to examine the evolution of PCI safety over time and the opportunity for further improvement," write the authors.

The primary outcome was contrast volume used during the procedure, which significantly decreased over the course of the study period (168.1 ± 77.6 mL in 2018 vs. 149.8 ± 71.2 mL in 2022).

The authors also note that patients deemed at higher risk of AKI by the NCDR CathPCI Registry risk model consistently received less contrast when compared with patients at lower risk of the complication (160.5 mL vs. 171.3 mL in 2018; 143.4 mL vs. 150.4 mL in 2022).

However, when looking at contrast use at the physician level (n=3,600 physicians), the authors found that 53% used less contrast, 38% used a similar amount and 9% used more contrast on average in 2022 vs. 2018. "When categorized by percent change, 77.1% did not significantly change the amount of contrast they used per procedure," note the authors.

"Since U.S. hospitals already receive quarterly site-level AKI rates within CathPCI, integrating additional strategies such as operator-level feedback describing the proportion of their cases treated within safe-contrast limits may further optimize contrast use and improve the safety of PCI," they suggest.