Does Administration of IV Contrast Impact Outcomes on Acute Ischemic Stroke Patients? A Propensity Score Matched Single Center Study
Shah K, Mayer SA, Harn MGV, Ismail M, Schultz L, Marin HL, Kole MK, and Miller DJ. Does Administration of IV Contrast Impact Outcomes on Acute Ischemic Stroke Patients? A Propensity Score Matched Single Center Study. Stroke 2019; 50.
Introduction: The AHA/ASA strongly recommend urgent noninvasive vascular imaging for suspected LVO patients.1 There remains concern about developing acute kidney injury (AKI) and/or contrast induced nephropathy (CIN) secondary to contrast exposure for CTA or DSA.2-8 It is unclear if contrast has any impact upon outcomes of endovascular thrombectomy (ET) patients, and if this differs from patients who do not undergo ET. Methods: A retrospective chart review was conducted upon 2384 consecutive patients who were admitted with acute ischemic stroke from 1/2014-8/2017. Patients were grouped into: ET (CTA+DSA), CTA Only, and No Contrast. Propensity score matching (PSM) was conducted for a 1:1:1 match between these 3 groups. The primary outcome was 90-day modified rankin scal (mRS). Patients were grouped into favorable (mRS ≤ 2) and unfavorable (mRS > 2). AKI was defined as an increase in serum creatinine (SCr) ≥ 0.3 within 48 hours while CIN was defined as an increase in SCr ≥ 0.5 or 25% at 48-72 hours9. Results: 124 patients were matched into each group. Patients that received contrast had higher rates of AKI at 48-72 hours; however, this was not statistically significant (8% CTA+DSA, 5% CTA only, and 3% no contrast, p = 0.228). Patients with poor outcome amongst all groups had statistically significant higher rates of baseline CKD (37% vs 24%, p = 0.038) and AKI (22% vs 11%, p = 0.025). Multivariable analysis for the ET subgroup shows no significant difference in outcomes with or without AKI; however, in the non-ET subgroup, presence of AKI was significantly associated with poor outcome (OR 1.25 (0.36, 4.34) and 19.05 (2.13, 170.72), respectively; p < 0.05). Conclusion: Rates of AKI do not differ significantly based on the administration of contrast. In our PSM population, those not undergoing ET have poorer outcomes if they suffer AKI; however, there is no difference in outcomes if patients receive ET.