title: Sodium bicarbonate plus N-acetylcysteine to prevent contrast-induced nephropathy in primary and rescue percutaneous coronary interventions: the BINARIO (BIcarbonato e N-Acetil-cisteina nell'infaRto mIocardico acutO) study.
abstract: OBJECTIVE
  Contrast-induced nephropathy (CIN) is a frequent and potentially harmful complication of percutaneous coronary interventions (PCI), especially in the setting of ST-elevation myocardial infarction (STEMI). We tested the efficacy of a sodium bicarbonate (SB)-based hydration in urgent PCI for STEMI.
  
  
  RESULTS
  From June 2009 to September 2010, 262 consecutive STEMI patients undergoing urgent PCI were prospectively enrolled and treated by SB-based hydration (154 mEq/L at 3 ml Kg-1 for one hour followed by 1 ml Kg-1 for six hours) (group A). As controls, 262 consecutive STEMI patients receiving 0.9% saline hydration (1 ml Kg-1 for 24 hours) before June 2009 were retrospectively enrolled (group B). Both groups received high-dose N-acetylcysteine (NAC). The primary endpoint was the composite of in-hospital death, need for dialysis and CIN (≥25% increase in serum creatinine at 48 hours). The two groups were comparable for baseline clinical and procedural characteristics, for Mehran risk score and baseline estimated glomerular filtration rate. The primary combined endpoint was significantly reduced in group A as compared to group B (9.2 vs. 18.7%, p=0.023) with a number needed to treat (NNT) of 11. Specifically, a significant reduction of both in-hospital death (2.3 vs. 6.1%, p=0.049, NNT 27) and CIN (8.0 vs. 14.1%, p=0.03, NNT 17) was observed, with no difference in the need for dialysis.
  
  
  CONCLUSIONS
  Our data indicate that hydration with sodium bicarbonate in addition to high-dose NAC in the setting of urgent PCI for STEMI is associated with a net clinical benefit.
authors.affiliation: Department of Cardiovascular Medicine and Center of Hemodialysis, Catholic University of the Sacred Heart, 00168 Rome, Italy. antoniomarialeone@gmail.com
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Alberto Ranieri
authors.initials: AR
authors.lastname: De Caterina
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Andrea
authors.initials: A
authors.lastname: Aurelio
authors.forename: Eloisa
authors.initials: E
authors.lastname: Basile
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Rocco
authors.initials: R
authors.lastname: Mongiardo
authors.forename: Mario Attilio
authors.initials: MA
authors.lastname: Mazzari
authors.forename: Antonino
authors.initials: A
authors.lastname: Buffon
authors.forename: Nicola
authors.initials: N
authors.lastname: Panocchia
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lioy
authors.forename: Antonio Giuseppe
authors.initials: AG
authors.lastname: Rebuzzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000139:chemically induced / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D017693:Sodium Bicarbonate; D000111:Acetylcysteine