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A randomized trial of intravenous N-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes

Authors

  • Zehra Jaffery MD,

    Corresponding author
    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
    • 1514 Jefferson Hwy, New Orleans, LA 70120, USA
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  • Anil Verma MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Christopher J. White MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Arthur G. Grant MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Tyrone J. Collins MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Mark A. Grise MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • James S. Jenkins MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Paul W. McMullan MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Rajan A. Patel MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • John P. Reilly MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Stanley N. Thornton MD,

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Stephen R. Ramee MD

    1. Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
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  • Disclosures: None of the authors have any conflict of interest related to this manuscript.

Abstract

Background: Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥25% above the baseline level within 72 hr of the administration of intravenous contrast. Results: There was no difference found for the primary end point with CIN in 16% of the NAC group and in 13% of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). Conclusion: In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN. © 2011 Wiley Periodicals, Inc.

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