Effectiveness of acetylcysteine in prevention of contrast nephropathy.
BACKGROUND
Acetylcysteine may provide prophylaxis against contrast nephropathy (CN) in some patients. Its benefit may vary according to the characteristics of patients and contrast used. The objective is to evaluate the effectiveness of oral acetylcysteine in preventing CN after coronary procedures in our practice.


METHODS
We prospectively studied 397 patients with a creatinine level equal to or above 1.3 mg/dl, diabetes mellitus, or 70+ years of age who underwent a coronary procedure. Patients were randomly assigned to receive either acetylcysteine or placebo and 0.9% saline before and after the contrast agent. High- or low-osmolality contrast was used according to the discretion of the interventional cardiologist. Serum creatinine was measured before and 24 to 48 hours after the procedure.


RESULTS
An increase of greater than or equal to 25% in the baseline creatinine level 24 to 48 hours after the procedure occurred in 14 (7.1%) of 196 acetylcysteine patients and in 17 (8.4%) of 201 placebo patients (p=0.62). In the acetylcysteine group, the mean baseline serum creatinine concentration was 1.30+/-0.56 mg/dl and increased 0.076+/-0.21 mg/dl 24 to 48 hours after administration of contrast, whereas in the placebo group, it was 1.27+/-0.51 mg/dl and increased 0.101+/-0.28 mg/dl (p=0.33). In the subgroup with estimated baseline creatinine clearance <60 ml/minute, no difference was found in the incidence of CN (9.1% in the acetylcysteine group; 11.7% in the placebo; p=0.66). By multivariate analysis, left ventricular ejection fraction less than or equal to 40%, volume of contrast >200 ml, and estimated creatinine clearance (but not acetylcysteine) were related to CN.


CONCLUSIONS
Oral acetylcysteine was not effective as a prophylactic treatment against CN for patients with a potential risk and submitted to coronary angiographic procedures with predominantly high-osmolality contrast.
Azmus
Alexandre D
AD
Hemodynamic Service, Institute of Cardiology of Rio Grande do Sul/Fundação Universitária de Cardiologia, Av. Princesa Isabel, 310 U. Pesquisa, Porto Alegre, RS, 90620-001, Brazil. pesquisa@cardiologia.org.br
Gottschall
Carlos
C
Manica
Andre
A
Manica
João
J
Duro
Kaue
K
Frey
Marcos
M
Bulcão
Lauro
L
Lima
Cristiane
C
D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001806:Blood Urea Nitrogen; D001938:Brazil / Q000453:epidemiology; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy; D003404:Creatinine / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome
D003287:Contrast Media; D003404:Creatinine; D000111:Acetylcysteine