Acetylcysteine, coronary procedure and prevention of contrast-induced worsening of renal function: which benefit for which patient?
OBJECTIVE
This study was designed to determine whether acetylcysteine could provide a protective effect on renal function in a population of patients with normal renal function or mild to moderate chronic renal failure, usually referred for a coronary procedure.


BACKGROUND
Contrast-induced nephropathy is a well-recognized complication of coronary angiography. Recent studies suggest that saline hydration and acetylcysteine reduce the incidence of contrast-induced worsening of renal function in patients with pre-existing chronic renal failure who are undergoing computed tomography examinations.


METHODS
One hundred eight patients were blindly and randomly assigned to receive either acetylcysteine or placebo before and after administration of contrast agent in association with a moderate hydration protocol. Serum creatinine and urea nitrogen were measured before and 24 hours after coronary procedure.


RESULTS
The mean serum creatinine concentration remained unchanged 24 hours after contrast agent administration in both groups: from 1.04 +/- 0.26 to 1.03 +/- 0.29 mg/dl in the acetylcysteine group and from 1.16 +/- 1.1 to 1.06 +/- 0.41 mg/dl in the control group (p = 0.29, for the comparison between two groups, NS). We divided the population into 3 subgroups according to their creatinine clearance: no significant change of serum creatinine concentration was observed in patients with normal renal function nor in patients with pre-existing mild to moderate chronic renal failure in both groups. There was no significant difference for the incidence of contrast-induced nephropathy between both groups (2 of the 53 patients in the acetylcysteine group and 3 of the 51 patients in the placebo group, p = 0.98, NS).


CONCLUSIONS
Our data do not support the systematic use of acetylcysteine before a coronary procedure in patients with normal renal function or mild to moderate chronic renal failure, to prevent contrast-induced nephropathy.
Kefer
Joëlle M
JM
Division of Cardiology, University of Louvain, Brussels, Belgium.
Hanet
Claude E
CE
Boitte
Sabine
S
Wilmotte
Léon
L
De Kock
Martine
M
D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
D015415:Biomarkers; D003287:Contrast Media; D016166:Free Radical Scavengers; D003404:Creatinine; D000111:Acetylcysteine