Prevention of contrast-induced nephropathy with N-acetylcysteine or sodium bicarbonate in patients with ST-segment-myocardial infarction: a prospective, randomized, open-labeled trial.
BACKGROUND
Contrast-induced nephropathy (CIN) is a serious condition in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. We compared the risk of acute CIN and the influence of preventive strategies in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.


RESULTS
A total of 720 patients were randomized in the Prevention of Contrast-induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (CINSTEMI) trial. Patients were randomly assigned in a 1:1:1:1 ratio to receive hydration with sodium chloride together with 1 of 4 prophylactic regimes (1) N-acetylcysteine (NAC), (2) sodium bicarbonate (NaHCO3) infusion, (3) NAC in combination with NaHCO3, or (4) hydration with sodium chloride infusion alone. Patients in cardiogenic shock were excluded. Acute CIN was defined as an increase in serum creatinine concentration >25% from the baseline value within a 3-day period. Overall, CIN occurred in 141 (21.9%) patients. The prevention treatment with NAC, NaHCO3, or the combined NAC and NaHCO3 did not reduce the rate of CIN significantly compared with hydration with intravenous sodium chloride infusion alone (20.1% versus 20.1% versus 20.8% versus 26.5%; P=NS). However, an increase in serum creatinine >25% from the baseline value to 30 day was significantly lower in patients treated with combined NAC and NaHCO3 (18.7% versus 19.1% versus 9.2% versus 21.3%; P=0.033).


CONCLUSIONS
Treatment with NAC or NaHCO3 did not reduce the rate of acute CIN significantly. Combined treatment with NAC and NaHCO3 may reduce the risk of renal dysfunction after 30 days.


BACKGROUND
http://www.clinicaltrials.gov. Unique identifier: NCT01160627.
From the Department of Cardiology, Odense University Hospital, Odense, Denmark (P.T., K.N.H., H.S.H., A.J., K.T.V., L.O.J.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., E.H.C., L.T.); and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (S.E.J., J.R.).
Per
P
Thayssen
Jens Flensted
JF
Lassen
Svend Eggert
SE
Jensen
Knud Nørregaard
KN
Hansen
Henrik Steen
HS
Hansen
Evald Høj
EH
Christiansen
Anders
A
Junker
Jan
J
Ravkilde
Leif
L
Thuesen
Karsten Tange
KT
Veien
Lisette Okkels
LO
Jensen
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D003287:Contrast Media; D017693:Sodium Bicarbonate; D003404:Creatinine; D000111:Acetylcysteine
ST-segment–elevation myocardial infarction; contrast-induced nephropathy