Related Experiment Video
Updated: Feb 18, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine
Steven D Weisbord1, Martin Gallagher1, Hani Jneid1
1From the Veterans Affairs (VA) Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh (S.D.W., P.M.P.); University of Sydney (M.G.) and the George Institute for Global Health, University of New South Wales (M.G., A.C.), Sydney, and the Menzies School of Health Research, Darwin, NT (A.C.) - all in Australia; Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston (H.J.); Minneapolis VA Health Care System and University of Minnesota, Minneapolis (S.G., E.O.M.); VA Cooperative Studies Program Coordinating Center (S.S.T., M.B., R.F., H.W., M.A., J.M., J.K.) and the Cardiology Section (D.L.B.), VA Boston Healthcare System, and Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School (D.L.B.) - all in Boston; VA Cooperative Studies Program Pharmacy Coordinating Center, Albuquerque, NM (T.A.C.); Stanford University Department of Medicine, Palo Alto (G.M.C.), and San Francisco VA Medical Center and University of California, San Francisco, San Francisco (K.S.) - all in California; and the VA Connecticut Healthcare System and Program of Applied Translational Research, Yale University, New Haven (C.R.P.).
Insights
Intravenous sodium bicarbonate and oral acetylcysteine did not prevent acute kidney injury or related adverse outcomes in high-risk patients undergoing angiography. The study found no significant benefit of either intervention over placebo for preventing major adverse events or kidney damage.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Intravenous sodium bicarbonate and oral acetylcysteine are commonly used to prevent acute kidney injury (AKI) after angiography.
- Evidence supporting their efficacy in preventing AKI and associated adverse outcomes is limited.
Purpose of the Study:
- To evaluate the efficacy of intravenous sodium bicarbonate and oral acetylcysteine in preventing contrast-associated AKI and adverse outcomes in high-risk patients undergoing angiography.
Main Methods:
- A 2-by-2 factorial randomized controlled trial involving 5177 high-risk patients scheduled for angiography.
- Patients received either intravenous sodium bicarbonate or sodium chloride, and oral acetylcysteine or placebo.
- The primary endpoint was a composite of death, need for dialysis, or a 50% increase in serum creatinine at 90 days.
Main Results:
- No significant difference in the primary endpoint between sodium bicarbonate and sodium chloride groups (4.4% vs. 4.7%, P=0.62).
- No significant difference in the primary endpoint between acetylcysteine and placebo groups (4.6% vs. 4.5%, P=0.88).
- No significant differences in contrast-associated AKI rates between any of the groups.
Conclusions:
- Intravenous sodium bicarbonate does not offer a benefit over sodium chloride for preventing adverse renal outcomes post-angiography.
- Oral acetylcysteine provides no benefit over placebo in this patient population.
- Neither intervention is effective in preventing major adverse events or contrast-associated AKI in high-risk patients undergoing angiography.
Background:
Intravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy.
Methods:
Using a 2-by-2 factorial design, we randomly assigned 5177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and 5 days of oral acetylcysteine or oral placebo; of these patients, 4993 were included in the modified intention-to-treat analysis. The primary end point was a composite of death, the need for dialysis, or a persistent increase of at least 50% from baseline in the serum creatinine level at 90 days. Contrast-associated acute kidney injury was a secondary end point.
Results:
The sponsor stopped the trial after a prespecified interim analysis. There was no interaction between sodium bicarbonate and acetylcysteine with respect to the primary end point (P=0.33). The primary end point occurred in 110 of 2511 patients (4.4%) in the sodium bicarbonate group as compared with 116 of 2482 (4.7%) in the sodium chloride group (odds ratio, 0.93; 95% confidence interval [CI], 0.72 to 1.22; P=0.62) and in 114 of 2495 patients (4.6%) in the acetylcysteine group as compared with 112 of 2498 (4.5%) in the placebo group (odds ratio, 1.02; 95% CI, 0.78 to 1.33; P=0.88). There were no significant between-group differences in the rates of contrast-associated acute kidney injury.
Conclusions:
Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury. (Funded by the U.S. Department of Veterans Affairs Office of Research and Development and the National Health and Medical Research Council of Australia; PRESERVE ClinicalTrials.gov number, NCT01467466 .).
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:31Acid Suppressive Drugs for Peptic Ulcer Disease: Antacids
However, this neutralization reaction between...
01:26Acute Coronary Syndrome V: Nursing Management
01:26Cardiac Catheterization IV: Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction