N-acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up.
BACKGROUND
Contrast-associated nephropathy (CAN) is associated with increased morbidity and mortality following percutaneous coronary intervention (PCI). N-acetylcysteine (NAC) has been shown to reduce the risk of nephropathy; however, the impact of NAC on long-term clinical outcomes has not been assessed.


METHODS
This randomized, double-blind, placebo-controlled trial enrolled 180 patients with moderate renal dysfunction undergoing PCI or coronary angiography with a high likelihood of ad hoc PCI; 171 patients completed the clinical follow-up. Patients received oral NAC (2000 mg/dose, n = 95) or placebo (n = 85) twice a day for 3 doses if randomized the night prior to the procedure, and 2 doses if randomized the day of the procedure. The primary end point was the incidence of a > or =25% increase in serum creatinine level 48 to 72 hours after PCI. Secondary end points were the inhospital incidence of death, nonfatal myocardial infarction, or urgent dialysis, and the 9-month incidence of death, nonfatal myocardial infarction, need for dialysis, or repeat hospitalization for cardiac reasons.


RESULTS
CAN occurred in 9.6% of patients assigned to NAC and 22.2% of patients assigned to placebo (P =.04); 1 patient receiving NAC required urgent dialysis. The inhospital composite end point occurred in 7 (7.4%) NAC-treated and 3 (3.5%) placebo-treated patients, P = NS. At 9 months, the composite end point occurred in 23 (24.2%) NAC-treated patients and 18 (21.2%) placebo-treated, P = NS.


CONCLUSIONS
Although high-dose NAC prevented periprocedural CAN, this benefit did not translate into a decrease in adverse outcomes over 9 months. Further studies to determine the clinical utility of this drug are required.
Miner
Steven E S
SE
University of Toronto and the Department of Medicine at the University Health Network, Toronto, Ontario, Canada.
Dzavik
Vladimir
V
Nguyen-Ho
Phong
P
Richardson
Robert
R
Mitchell
Jan
J
Atchison
Deborah
D
Seidelin
Peter
P
Daly
Paul
P
Ross
John
J
McLaughlin
Peter R
PR
Ing
Douglas
D
Lewycky
Peter
P
Barolet
Alan
A
Schwartz
Leonard
L
D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged
D003287:Contrast Media; D003404:Creatinine; D000111:Acetylcysteine