Contrast-induced nephropathy remains a relevant complication of percutaneous coronary interventions (PCI), particularly in patients with multiple comorbidities and complex coronary anatomies. Dynamic Coronary Roadmap (DCR) is a software tool that superimposes a real-time angiographic reconstruction onto fluoroscopy, allowing device guidance with reduced contrast utilization. The aim of this study was to evaluate whether the use of DCR reduces the total volume of contrast used during PCI at an Argentine center.
Study Characteristics
An observational, retrospective, single-center study was conducted including 480 consecutive patients who underwent PCI between January and December 2024. Patients were divided into two groups: DCR-guided PCI (n=201; 41.8%) and conventional angiography-guided PCI (n=279; 58.2%). Median age was similar between groups (69 and 68 years, respectively), with a male predominance of approximately 75%. All procedures were coronary angioplasties. The proportion of complex procedures was significantly higher in the DCR group compared with the control group (39.6% vs. 17.6%; p<0.001). Complex PCI was defined as procedures involving multivessel treatment, unprotected left main coronary artery, true bifurcations, saphenous vein grafts, or severely calcified or thrombotic lesions.
The primary endpoint was the total volume of contrast used per procedure. Secondary endpoints included radiation exposure, assessed by air kerma and dose–area product, and the change in serum creatinine between the preprocedural period and hospital discharge.
Dynamic Coronary Roadmap in PCI: impact on contrast volume reduction
Use of DCR was associated with a significant reduction in total contrast volume, with a median of 120 mL (IQR 90–158) compared with 140 mL (IQR 100–200) in the control group (p=0.007). This value reflected overall procedural contrast consumption, including diagnostic coronary angiography. When analyzing contrast use during the angioplasty phase alone, a significant reduction was also observed: 100 mL (IQR 70–140) in the DCR group versus 120 mL (IQR 80–180) in the control group (p=0.001). In multivariable analysis adjusted for age, sex, treated vessel, and PCI complexity, DCR use was associated with an average reduction of 37.3 mL of contrast per patient (95% CI 24.3–50.5; p<0.001).
Regarding secondary outcomes, no significant differences were observed in radiation exposure between groups. Median air kerma was 517 mGy in the DCR group and 514 mGy in the control group (p=0.567), while dose–area product was 41.7 Gy·cm² and 45.5 Gy·cm², respectively (p=0.846). Likewise, no differences were found in renal function: the change in serum creatinine was 0.10 mg/dL in both groups (p=0.813), with no increase in the incidence of contrast-induced nephropathy.
Conclusions: benefits of DCR in complex coronary angioplasty
The use of DCR during coronary angioplasty was associated with a consistent reduction in contrast volume, even in more complex procedures, without increasing radiation exposure or adversely affecting renal function. These findings support its use as a practical strategy to reduce contrast burden in patients at increased risk of renal impairment.
Original Title: Reduction in Contrast Use through the Application of the Dynamic Coronary Roadmap in Coronary Angioplasty.
Reference: Marcelo A. Abud, Facundo Villa, Ignacio L. Paganini, Javier Cóggiola, Juan P. De Brahi. Instituto Cardiovascular San Gerónimo, Servicio de Terapéutica Endovascular. Revista Argentina de Cardiología 2025;93:358–363.
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