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Emergency pretreatment enables PCI in contrast-allergic patients
21 November 2008
MedWire News: Emergency steroid pretreatment for contrast allergy before percutaneous coronary intervention (PCI) appears well tolerated and effective, preliminary data indicate.
It is currently unclear whether a previous adverse reaction to contrast media should be considered an absolute, relative, or no contraindication; contrast-induced reactions can be fatal, although recurrent reactions tend to be mild.
“Five professional societies have issued guidelines or reviews regarding contrast reactions, but none offer firm guidance for emergency pretreatment of contrast-allergic patients,” write James Blankenship (Geisinger Medical Center, Danville, Pennsylvania, USA) and co-authors in the American Journal of Cardiology.
In the present study, Blankenship et al hypothesized that emergency pretreatment with steroids would allow such patients to undergo emergency PCI for ST-elevation myocardial infarction without experiencing adverse reactions.
They retrospectively identified all 501 patients who had undergone PCI at a single center over a 2-year period, six of whom (1.2%) reported a previous adverse reaction to iodinated contrast, such as rash, acute bronchospasm, or anaphylaxis.
These six individuals were pretreated with a combination of steroids and histamine H1/H2 blockers (methylprednisolone 80 mg, cimetidine 300 mg, prochlorperazine 10 mg, and montelukast 10 mg). The drugs were given in the emergency department or catheterization laboratory 10–50 minutes before PCI.
No adverse or allergic reaction occurred in any patient either during or after PCI, Blankenship and team report. This is an important finding, they say, which “may be surprising to cardiologists” despite a large body of radiology literature suggesting that repeat administration of contrast to contrast-allergic patients is rarely dangerous.
They conclude: “Some patients with previous contrast reaction may undergo emergency catheterization without adverse consequences, although the safety of this approach has not been proved.”
