ABSTRACT
Iodinated contrast agents used in the cardiac catheterization laboratory are the mainstay of visualization of coronary and peripheral vasculature as well as cardiac anatomy. Low osmolar and iso-osmolar agents have been developed to mitigate adverse events while providing optimal imaging. This chapter discusses contrast agents and the evidence-based strategies to prevent adverse events. First-generation, high-osmolar contrast media (HOCM) are ionic monomers, which consist of a single, negatively charged tri-iodinated benzene ring attached to a cation. Second-generation, low osmolar contrast media (LOCM) were designed to minimize side effects. LOCM are also available as nonionic monomers. Contrast agents are used in the cardiac catheterization lab for coronary arteriography, ventriculography, aortography, and peripheral arterial assessment. CKD is the primary risk factor for CI-AKI. Other risk factors include diabetes, advanced age, contrast dose, hypotension, multiple recent exposures to contrast, and anemia.
