title: A randomized trial of intravenous n-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes.
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).
  
  
  CONCLUSIONS
  In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.
authors.affiliation: Department of Cardiovascular Diseases, The John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana, USA. zjaffery@ochsner.org
authors.forename: Zehra
authors.initials: Z
authors.lastname: Jaffery
authors.forename: Anil
authors.initials: A
authors.lastname: Verma
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: White
authors.forename: Arthur G
authors.initials: AG
authors.lastname: Grant
authors.forename: Tyrone J
authors.initials: TJ
authors.lastname: Collins
authors.forename: Mark A
authors.initials: MA
authors.lastname: Grise
authors.forename: James S
authors.initials: JS
authors.lastname: Jenkins
authors.forename: Paul W
authors.initials: PW
authors.lastname: McMullan
authors.forename: Rajan A
authors.initials: RA
authors.lastname: Patel
authors.forename: John P
authors.initials: JP
authors.lastname: Reilly
authors.forename: Stanley N
authors.initials: SN
authors.lastname: Thornton
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Ramee
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000975:Antioxidants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D055820:New Orleans; D010919:Placebos; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D015415:Biomarkers; C525030:CST3 protein, human; D003287:Contrast Media; D055316:Cystatin C; D010919:Placebos; D003404:Creatinine; D000111:Acetylcysteine