Key result
PCI contrast volume dropped by ~18 ml from 2018 to 2022 across risk groups.
Why the study?
Current trends in contrast volume use during PCI in the U.S. and their relationship with pre-procedural AKI risk remain unclear despite quality improvement efforts.
Observational (n=3,126,559)
Yes
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The observation that many interventionalists did not alter their practice patterns over the past five years underscores a compelling need for new strategies to continue and accelerate the modest improvements documented in these analyses. Implementing strategies to proactively guide safe contrast levels is one strategy to consider … 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.”
Despite a modest overall reduction in contrast volume during PCI from 2018 to 2022, significant physician-level variation persists, highlighting opportunities for targeted quality improvement to reduce AKI risk.
percutaneous coronary intervention; acute kidney injury; iodinated contrast; quality of care Acute kidney injury (AKI) is the most prevalent complication after percutaneous coronary intervention (PCI) and a key focus of PCI quality improvement.AKI risk can be reduced by minimizing procedural contrast use, as emphasized in clinical practice guidelines.(1)Despite ongoing quality improvement efforts, including the ACC National Cardiovascular Data Registry (NCDR) CathPCI registry that provides quarterly, risk-adjusted institutional AKI rates to quantify performance and monitor changes over time, current contrast use trends in the U.S. and their relationship with pre-procedural AKI risk remain unclear.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.To better understand current practice patterns and the potential need for further quality improvement efforts, we examined trends in contrast volume used during PCI from 2018 to 2022 with a focus on physician variability in their change in contrast volume use.For this analysis, we leveraged the National Cardiovascular Disease Registry (NCDR) CathPCI Registry, a prospective national registry collecting data on all patients undergoing PCI from over 1,600 US institutions.The registry is supported by the American College
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Ikemura et al. (2025) conducted an observational in Patients undergoing percutaneous coronary intervention (PCI) (n=3,126,559). PCI performed in 2022 vs. PCI performed in 2018 was evaluated on Contrast volume used during PCI (MD -17.7 ml, 95% CI -18.0 to -17.5). Between 2018 and 2022, the mean contrast volume used during PCI decreased by an adjusted 17.7 ml, with higher-risk patients persistently receiving less contrast.
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