Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions.
OBJECTIVES
Oral steroids are routinely administered in the United States for prophylaxis of iodinated contrast media hypersensitivity (ICMH). We studied the impact of short-term steroid use in diabetic patients with ICMH undergoing nonemergent coronary angiography.


METHODS
We retrospectively analyzed records of diabetic patients with and without ICMH who underwent nonemergent coronary angiography at our center. Primary study endpoint was 30-day major adverse cardiac events (MACE) and secondary endpoints were pre- and postprocedure fasting blood glucose (FBG), highest in hospital blood glucose, pre- and postprocedure systolic blood pressure (SBP), and use of intravenous insulin and antihypertensive medications.


RESULTS
A total of 88 diabetics with ICMH (study group) and 76 diabetics without ICMH (control group) undergoing angiography were enrolled. Demographics and hemoglobin A1c values were similar in both groups. Preprocedural FBG was significantly higher in the study group. The study group had significantly higher post angiography FBG (239.93 + 96.88 mg/dl vs. 156.6 + 59.88 mg/dl) and greater use of intravenous (IV) insulin (67.27% vs. 32.43%). Further, those who received steroids had significantly higher systolic SBP postprocedure (146.16 + 25.35 mmHg vs. 130.8 + 21.59 mmHg), a higher incidence of severe hypertension and use of IV antihypertensive medications (80.95% vs. 19.05%) periprocedurally. There were no differences in 30-day MACE between groups.


CONCLUSION
Short-term steroid use for ICMH results in a significant increase in surrogate markers for adverse clinical events after coronary procedures. Study findings highlight the need for better periprocedural management of these patients and to limit steroid prophylaxis to those with only true ICMH.
['Amr|Bashar S|BS|', 'Lippmann|Matthew|M|0000-0003-3485-0057', 'Tobbia|Patrick|P|', 'Isom|Nicholas|N|0000-0003-3251-2054', 'Dalia|Tarun|T|', 'Buechler|Tyler|T|', 'Pierpoline|Michael|M|', 'Patel|Nilay|N|0000-0002-0799-1922', 'Hockstad|Eric|E|', 'Wiley|Mark|M|', 'Tadros|Peter|P|', 'Mehta|Ashwani|A|', 'Earnest|Matthew|M|', 'Chen|John G|JG|', 'Gupta|Kamal|K|0000-0002-2440-9033']
D061605:Administration, Intravenous D000284:Administration, Oral D000368:Aged D000959:Antihypertensive Agents D015415:Biomarkers D001786:Blood Glucose D001794:Blood Pressure D006328:Cardiac Catheterization D003287:Contrast Media D017023:Coronary Angiography D003324:Coronary Artery Disease D003920:Diabetes Mellitus D004342:Drug Hypersensitivity D005260:Female D006801:Humans D006973:Hypertension D007004:Hypoglycemic Agents D007328:Insulin D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013256:Steroids D013997:Time Factors D016896:Treatment Outcome
contrast media coronary angiography diabetes mellitus glucocorticoids