Risks and Complications of Coronary Angiography: Contrast Related Complications

Since Wilhelm Röntgen reported his novel discovery of the XRay in 1895(Röntgen, 1898 as cited in Weinmann etal., 2005), the Diagnostic imaging has been an integral part of medicine. He was decorated by the second class of Prussian crown medal and he was also awarded the first physic Nobel Prize at 1901. LevyDorn was another pioneer in radiology who understood the potential importance of X-ray in medicine and opened a daily private office for medical examination with X-ray in 1896 just one year after innovation of X-ray by Röntgen. He pointed to the danger of this method to the living organism very early (Hierholzer K & Hierholzer J 1997; Nitze, 1895; as cited in Hierholzer K & Hierholzer J, 2002) Since X-rays are not sufficiently absorbed by soft tissue, contrast media (CM) is used to highlight organs or pathologies. Osborne etal reported that inorganic Iodine enhanced the urinary tracts X-ray images (Osborn etal., 1923). But the most important contributor to the field of urological imaging came from the field of agriculture when A Binz and C Räth, two scientists from the Berlin agricultural college synthesized a new organic iodinated molecule "Selectan"(Binz & Räth 1928 as cited in Hierholzer K & Hierholzer J, 2002), and a research fellow used this agent in clinical investigations. (Swick 1929a, 1929b as cited in Hierholzer K & Hierholzer J, 2002; Weinmann etal., 2005). In 1928 an urologist, Forssmann, used one of these agents in his own coronary arteries (Hricak & Barbarive 1984).This was an unexpected methodological contribution of urological research to cardiology. From 1929 on, serial production of Uroselectan was established. This agent was a big step forward in safety, because ionic iodide (Sodium Iodide and Lithium Iodide) cannot be used in a clinical setting. In the early 1950s, a new generation of iodinated agents was launched, which were derivatives of triiodinated benzoic acid, e.g. diatrizoate (Urografin etc.). These agents became standard in diagnostic imaging for the next 30 years and are still widely used in many countries. Almen suggested that non-ionic molecules could reduce osmolality (Almen, 1969, as cited in Weinmann etal., 2005), an idea that was the basis of safer compounds that entered routine clinical use in the 1980s. Water-soluble, non-ionic iodinated contrast agents are now the workhorses in contrast based imagings. More than 90% of contrasts media are used in western countries are non-ionic CM. There are two main complications of contrast media. The aim of this chapter is to discuss these two major side effects of CM. the most important of these two complication is contrast induced nephropathy (CIN) which will be described in details and the other is anaphylaxis reactions to the CM which will be mentioned briefly at the end of the chapter.