title: Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty.
abstract: BACKGROUND
  The aim of this study was to assess the effects of N-acetylcysteine (N-ACC) on contrast-induced nephropathy (CIN) defined by Cystatin C (Cys-C) serum levels and to evaluate the influence of Cys-C on clinical outcome in patients with ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  In total, 251 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) were randomized to either high-dose N-ACC (2 × 1200 mg/d for 48 h) with optimal hydration or placebo plus optimal hydration. Serum Cys-C was measured at baseline, immediately, 24, 48 and 72 h after PCI. CIN was defined as an increase in serum Cys-C levels of 25% or more from baseline within 72 h after PCI. Major adverse cardiac events (MACE)--defined as death, recurrent infarction and congestive heart failure--within 6 months were recorded.
  
  
  RESULTS
  Baseline Cys-C was 1294 ± 611 and 1352 ± 811 ng/mL (p = 0.54) for the N-ACC and placebo group, respectively. There was a steady increase in Cys-C in both groups within the first 72 h after randomization. CIN occurred in 74.6 and in 70.4% of patients in the N-ACC and placebo group, respectively (p = 0.46). The magnitude of increase in the serum concentration of Cys-C was an independent predictor for MACE after 6 months of follow-up.
  
  
  CONCLUSIONS
  High-dose N-ACC does not provide additional benefit over placebo with respect to Cys-C defined CIN in STEMI patients undergoing primary PCI. The magnitude of increase in Cys-C serum levels in the early course after STEMI is a predictor of medium-term MACE.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Droppa
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Patrick
authors.initials: P
authors.lastname: Blase
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Volker
authors.initials: V
authors.lastname: Adams
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D003287:Contrast Media; D055316:Cystatin C; D000111:Acetylcysteine