Background Patients with acute myocardial infarction undergoingprimary angioplasty are at high risk for contrast-medium–inducednephropathy because of hemodynamic instability, the need fora high volume of contrast medium, and the lack of effectiveprophylaxis. We investigated the antioxidant N-acetylcysteinefor the prevention of contrast-medium–induced nephropathyin patients undergoing primary angioplasty.
Methods We randomly assigned 354 consecutive patients undergoingprimary angioplasty to one of three groups: 116 patients wereassigned to a standard dose of N-acetylcysteine (a 600-mg intravenousbolus before primary angioplasty and 600 mg orally twice dailyfor the 48 hours after angioplasty), 119 patients to a doubledose of N-acetylcysteine (a 1200-mg intravenous bolus and 1200mg orally twice daily for the 48 hours after intervention),and 119 patients to placebo.
Results The serum creatinine concentration increased 25 percentor more from baseline after primary angioplasty in 39 of thecontrol patients (33 percent), 17 of the patients receivingstandard-dose N-acetylcysteine (15 percent), and 10 patientsreceiving high-dose N-acetylcysteine (8 percent, P<0.001).Overall in-hospital mortality was higher in patients with contrast-medium–inducednephropathy than in those without such nephropathy (26 percentvs. 1 percent, P<0.001). Thirteen patients (11 percent) inthe control group died, as did five (4 percent) in the standard-doseN-acetylcysteine group and three (3 percent) in the high-doseN-acetylcysteine group (P=0.02). The rate for the compositeend point of death, acute renal failure requiring temporaryrenal-replacement therapy, or the need for mechanical ventilationwas 21 (18 percent), 8 (7 percent), and 6 (5 percent) in thethree groups, respectively (P=0.002).
Conclusions Intravenous and oral N-acetylcysteine may preventcontrast-medium–induced nephropathy with a dose-dependenteffect in patients treated with primary angioplasty and mayimprove hospital outcome. (ClinicalTrials.gov number, NCT00237614
[ClinicalTrials.gov]
.)
Source Information
From the Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, Milan.
Address reprint requests to Dr. Marenzi at Centro Cardiologico Monzino, Via Parea 4, 20138 Milan, Italy, or at giancarlo.marenzi{at}ccfm.it.
N-Acetylcysteine and Contrast-Induced Nephropathy
Aguiar-Souto P., Valero-González S., Domínguez J. F. O., Wolak A., Cafri C., Zahger D., Balderramo D. C., Ritz E., Marenzi G., Lauri G., Bartorelli A. L.
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N Engl J Med 2006;
355:1497-1500, Oct 5, 2006.
Correspondence
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