N-acetylcysteine-enhanced contrast provides cardiorenal protection.
OBJECTIVE
We sought to evaluate the cardiac and renal effects of an N-acetylcysteine (NAC)-enhanced intracoronary radiographic contrast agent.


BACKGROUND
Recent studies suggest that high-dose NAC provides better protection from contrast-induced nephropathy, and the antioxidant properties of NAC may also provide cardiac protection. The use of angiographic contrast agents as a drug delivery vehicle for cardiorenal protection effects has not been investigated.


METHODS
In a pig model of prolonged cardiac ischemia-reperfusion, NAC-enhanced contrast medium was tested and compared with iopamidol contrast only. Myocardium and renal function were assessed after 24 h.


RESULTS
There was no significant difference in the area-at-risk for myocardial infarction (MI) between contrast only and NAC-enhanced contrast medium. In contrast, MI size was about 40% smaller in NAC-enhanced contrast medium-treated animals. These findings were associated with a significant difference in MI morphology. MIs in the NAC-enhanced contrast medium group had a mottled appearance, whereas in the contrast only group they were homogeneous and had a discrete border zone. These differences could explain a higher incidence of periprocedural ventricular arrhythmias in the NAC-enhanced contrast medium group. Histopathological analysis of the myocardium revealed a reduction in programmed cell death by NAC-enhanced contrast medium that may explain the increase in ischemia tolerance. Last, NAC-enhanced contrast medium administration blunted the rise in serum creatinine levels by about 60% and protected from renotubular apotosis.


CONCLUSIONS
NAC-enhanced contrast medium reduces MI size and protects renal function in a pig model of ischemia and reperfusion.
Meyer
Markus
M
Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA. markus.meyer@vtmednet.org
LeWinter
Martin M
MM
Bell
Stephen P
SP
Chen
Zengyi
Z
Selby
Donald E
DE
Singla
Dinender K
DK
Dauerman
Harold L
HL
D000111:Acetylcysteine / Q000009:adverse effects / Q000494:pharmacology*; D015906:Angioplasty, Balloon, Coronary; D000818:Animals; D017209:Apoptosis; D003287:Contrast Media / Q000009:adverse effects / Q000494:pharmacology*; D003404:Creatinine / Q000097:blood; D004195:Disease Models, Animal; D005240:Feasibility Studies; D016166:Free Radical Scavengers / Q000009:adverse effects / Q000494:pharmacology*; D007479:Iopamidol / Q000009:adverse effects / Q000494:pharmacology*; D007668:Kidney / Q000187:drug effects; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D009203:Myocardial Infarction; D009206:Myocardium; D012307:Risk Factors; D013552:Swine
D003287:Contrast Media; D016166:Free Radical Scavengers; D003404:Creatinine; D007479:Iopamidol; D000111:Acetylcysteine