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(Circulation. 2000;101:2172.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Randomized Trial of Contrast Media Utilization in High-Risk PTCA

The COURT Trial

Charles J. Davidson, MD; Warren K. Laskey, MD; James B. Hermiller, MD; J. Kevin Harrison, MD; William Matthai, Jr, MD; Ronald E. Vlietstra, MD; Jeffrey A. Brinker, MD; Dean J. Kereiakes, MD; Joseph B. Muhlestein, MD; Alexandra Lansky, MD; Jeffrey J. Popma, MD; Maurice Buchbinder, MD; John W. Hirshfeld, Jr, MD

From Northwestern Memorial Hospital, Chicago, Ill (C.J.D.); University of Maryland Hospital, Baltimore (W.K.L.); The Care Group, Indianapolis, Ind (J.B.H.); Duke University Medical Center, Durham, NC (J.K.H.); Presbyterian Medical Center, Philadelphia, Pa (W.M.); Lakeland Regional Medical Center, Lakeland, Fla (R.E.V.); Johns Hopkins Hospital, Baltimore, Md (J.A.B.); Christ Hospital/Lindner Center, Cincinnati, Ohio (D.J.K.); Latter Day Saints Hospital, Salt Lake City, Utah (J.B.M.); Washington Hospital Center, Washington, DC (A.L., J.J.P.); Scripps Memorial Hospital, La Jolla, Calif (M.B.); and University of Pennsylvania Medical Center, Philadelphia (J.W.H.).

Correspondence to Charles J. Davidson, MD, Northwestern University Medical School, Feinberg Pavilion, Suite 8-526, 251 E Huron St, Chicago, IL 60611. E-mail cdavidso{at}nmh.org

Background—Previous in vitro and in vivo studies have suggested an association between thrombus-related events and type of contrast media. Low osmolar contrast agents appear to improve the safety of diagnostic and coronary artery interventional procedures. However, no data are available on PTCA outcomes with an isosmolar contrast agent.

Methods and Results—A multicenter prospective randomized double-blind trial was performed in 856 high-risk patients undergoing coronary artery intervention. The objective was to compare the isosmolar nonionic dimer iodixanol (n=405) with the low osmolar ionic agent ioxaglate (n=410). A composite variable of in-hospital major adverse clinical events (MACE) was the primary end point. A secondary objective was to evaluate major angiographic and procedural events during and after PTCA. The composite in-hospital primary end point was less frequent in those receiving iodixanol compared with those receiving ioxaglate (5.4% versus 9.5%, respectively; P=0.027). Core laboratory defined angiographic success was more frequent in patients receiving iodixanol (92.2% versus 85.9% for ioxaglate, P=0.004). There was a trend toward lower total clinical events at 30 days in patients randomized to iodixanol (9.1% versus 13.2% for ioxaglate, P=0.07). Multivariate predictors of in-hospital MACE were use of ioxaglate (P=0.01) and treatment of a de novo lesion (P=0.03).

Conclusions—In this contemporary prospective multicenter trial of PTCA in the setting of acute coronary syndromes, there was a low incidence of in-hospital clinical events for both treatment groups. The cohort receiving the nonionic dimer iodixanol experienced a 45% reduction in in-hospital MACE when compared with the cohort receiving ioxaglate.

Key Words: contrast media • angioplasty • myocardial infarction

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