The use of software that projects a virtual coronary roadmap onto the fluoroscopy led to significantly reduced amounts of contrast during percutaneous coronary intervention (PCI), new randomized trial results show. Javier Escaned, MD, PhD, Hospital Clinico San Carlos and Complutense University of Madrid, presented these findings during a late-breaking trial session Tuesday at EuroPCR 2023 in Paris. Reducing the use of iodinated contrast will lower the risk of contrast-induced nephropathy during PCI. The Dynamic Coronary Roadmap (DCR) projects a virtual, motion-compensated coronary roadmap overlay onto the fluoroscopy, which could potentially mean less contrast is needed, but evidence of this is lacking. Therefore, the DCR4Contrast trial, sponsored by Philips Medical Systems, the software manufacturer, set out to evaluate the DCR’s utility in reducing contrast. DCR4Contrast randomized 371 patients undergoing PCI at centers in Belgium, Israel, Spain and the U.S. to receive either DCR or conventional angiographic guidance. The primary endpoint was total volume of contrast administered. At baseline, the patients were well-matched, with similar mean age (approximately 65.8 years), about 79% male and similar percentages of co-morbidities. When stratified according to vessel SYNTAX score, vessels with the lowest score (<4) showed no significant difference in the amount of contrast used. However, in the two higher tertiles, the control group received significantly more contrast than the DCR group: SYNTAX score ≥4 to <8 (control: 92.9±51.7 mL vs. DCR 62.9±47.8 mL, p<0.001) and ≥8 (control: 115.2±60.7 mL vs. 70.4± 49.6mL, p<0.001) Both groups had similar rates of procedural success (control 100% vs. DCR 99.4%, p>0.99), and there was one major adverse cardiac or cerebrovascular event in the DCR arm (0.6%, p>0.99 vs. control). Procedural time was numerically shorter in the DCR group, but this did not reach statistical significance (control 36.1±30.5 minutes vs. DCR 33.7±25.9 minutes, p=0.28). There was also less radiation used in the DCR group, but again, the difference was not statistically significant (control 629.0±649.5 mGy vs. DCR 535.3±396.2 mGy, p=0.20). “In this trial, DCR was demonstrated to be a valuable tool to reduce contrast for patients undergoing PCI,” Escaned concluded. “This is especially relevant in the context of the growing use of ultra-low contrast PCI to treat complex or high-risk patients and in reducing the risk of contrast-induced nephropathy.”