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Inorganic nitrate benefits contrast-induced nephropathy after coronary angiography for acute coronary syndromes: the
Daniel A Jones1,2,3, Anne-Marie Beirne1,2, Matthew Kelham1,2
1William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK.
European Heart Journal
|March 21, 2024
Summary
Inorganic nitrate significantly reduced contrast-induced nephropathy (CIN) in high-risk patients undergoing coronary angiography. This treatment also improved kidney function and reduced major adverse cardiac events (MACE).
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a significant cause of morbidity and mortality in patients undergoing coronary angiography.
- Pre-clinical studies suggest inorganic nitrate, a nitric oxide precursor, offers renoprotection, but clinical translation is lacking.
- There is a critical need for effective strategies to prevent CIN in high-risk populations.
Purpose of the Study:
- To evaluate the efficacy of inorganic nitrate in preventing CIN in patients with acute coronary syndromes (ACS) undergoing coronary angiography.
- To assess the impact of inorganic nitrate on secondary outcomes, including kidney function, procedural myocardial infarction, and major adverse cardiac events (MACE).
Main Methods:
- A double-blind, randomized, single-centre, placebo-controlled trial (NITRATE-CIN) was conducted.
- High-risk patients presenting with ACS were randomized to receive either potassium nitrate or placebo daily for 5 days.
- Primary endpoint was CIN; secondary endpoints included estimated glomerular filtration rate (eGFR) at 3 months, procedural myocardial infarction, and MACE at 12 months.
Main Results:
- Inorganic nitrate significantly reduced CIN rates (9.1% vs. 30.5%, P < .001) compared to placebo.
- Treatment with inorganic nitrate led to lower rates of procedural myocardial infarction (2.7% vs. 12.5%, P = .003).
- Improved 3-month renal function (eGFR change: 5.17 mL/min) and reduced 1-year MACE (9.1% vs. 18.1%, P = .001) were observed with inorganic nitrate.
Conclusions:
- A short course of inorganic nitrate effectively reduces CIN in high-risk patients undergoing coronary angiography for ACS.
- Inorganic nitrate administration improved kidney outcomes at 3 months and reduced MACE at 1 year post-procedure.
- These findings support inorganic nitrate as a potential therapeutic agent for preventing CIN and improving cardiovascular outcomes.
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