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Published on: May 28, 2019
N-acetylcysteine and contrast-induced nephropathy in primary angioplasty
Giancarlo Marenzi1, Emilio Assanelli, Ivana Marana
1Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
Insights
N-acetylcysteine effectively prevents contrast-medium-induced nephropathy in patients undergoing primary angioplasty. This antioxidant treatment, particularly at higher doses, significantly reduces kidney damage and improves patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Patients undergoing primary angioplasty face high risk of contrast-medium-induced nephropathy.
- Hemodynamic instability and high contrast volumes complicate prophylaxis.
Purpose of the Study:
- To investigate N-acetylcysteine as a preventative agent for contrast-medium-induced nephropathy.
- To assess the dose-dependent effect of N-acetylcysteine.
Main Methods:
- 354 patients undergoing primary angioplasty were randomized into three groups.
- Groups received placebo, standard-dose N-acetylcysteine, or double-dose N-acetylcysteine.
- Treatment involved intravenous and oral N-acetylcysteine for 48 hours post-procedure.
Main Results:
- Contrast-induced nephropathy occurred in 33% of placebo vs. 15% (standard) and 8% (high dose) of N-acetylcysteine groups (P<0.001).
- In-hospital mortality was significantly lower in N-acetylcysteine groups (4-3%) compared to placebo (11%) (P=0.02).
- Composite endpoint rates (death, renal failure, ventilation) were significantly reduced with N-acetylcysteine (7-5%) vs. placebo (18%) (P=0.002).
Conclusions:
- N-acetylcysteine, administered intravenously and orally, effectively prevents contrast-medium-induced nephropathy.
- A dose-dependent effect was observed, with higher doses yielding better outcomes.
- N-acetylcysteine treatment improved hospital outcomes in patients undergoing primary angioplasty.
Background:
Patients with acute myocardial infarction undergoing primary angioplasty are at high risk for contrast-medium-induced nephropathy because of hemodynamic instability, the need for a high volume of contrast medium, and the lack of effective prophylaxis. We investigated the antioxidant N-acetylcysteine for the prevention of contrast-medium-induced nephropathy in patients undergoing primary angioplasty.
Methods:
We randomly assigned 354 consecutive patients undergoing primary angioplasty to one of three groups: 116 patients were assigned to a standard dose of N-acetylcysteine (a 600-mg intravenous bolus before primary angioplasty and 600 mg orally twice daily for the 48 hours after angioplasty), 119 patients to a double dose of N-acetylcysteine (a 1200-mg intravenous bolus and 1200 mg orally twice daily for the 48 hours after intervention), and 119 patients to placebo.
Results:
The serum creatinine concentration increased 25 percent or more from baseline after primary angioplasty in 39 of the control patients (33 percent), 17 of the patients receiving standard-dose N-acetylcysteine (15 percent), and 10 patients receiving high-dose N-acetylcysteine (8 percent, P<0.001). Overall in-hospital mortality was higher in patients with contrast-medium-induced nephropathy than in those without such nephropathy (26 percent vs. 1 percent, P<0.001). Thirteen patients (11 percent) in the control group died, as did five (4 percent) in the standard-dose N-acetylcysteine group and three (3 percent) in the high-dose N-acetylcysteine group (P=0.02). The rate for the composite end point of death, acute renal failure requiring temporary renal-replacement therapy, or the need for mechanical ventilation was 21 (18 percent), 8 (7 percent), and 6 (5 percent) in the three groups, respectively (P=0.002).
Conclusions:
Intravenous and oral N-acetylcysteine may prevent contrast-medium-induced nephropathy with a dose-dependent effect in patients treated with primary angioplasty and may improve hospital outcome. (ClinicalTrials.gov number, NCT00237614[ClinicalTrials.gov]).
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