title: Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) is a risk factor for contrast-induced nephropathy (CIN). We investigated whether pretreatment with statin, N-acetylcysteine (NAC) and sodium bicarbonate (NaHCO3) reduces the risk of CIN.
  
  
  METHODS
  We conducted a prospective trial and enrolled a total of 334 ST-segment elevation myocardial infarction (STEMI) patients. Patients were divided into four groups: Group I (statin 40mg), Group II (statin 80mg), Group III (statin 80mg plus NAC 1200mg) and Group IV (regimen of group III plus NaHCO3 154mEq/L). CIN was defined as ≥25% or ≥0.5mg/dL increase in serum creatinine from the baseline within the 72h after PCI.
  
  
  RESULTS
  CIN occurred in 72 (21.6%) patients. The incidence of CIN was the lowest in the group III (14.3%), and multivariate analysis showed the lower incidence of CIN in group III compared to Group I [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.13-0.64, p=0.002]. Admission hyperglycemia [(AHG)>198mg/dL] (OR 2.20, 95% Cl 1.20-3.68, p=0.011) and the use of intra-aortic balloon pump (IABP) (OR 4.20, 95% CI 1.38-12.78, p=0.016) were independent predictors for CIN. The CIN (OR 9.00, 95% CI 1.30-62.06, p=0.026) was an independent predictor for in-hospital mortality.
  
  
  CONCLUSIONS
  Combination of high-dose statin plus NAC was associated with lower incidence of CIN in patients with STEMI who underwent primary PCI compared to statin only.
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Public Health, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Soo Hwan
authors.initials: SH
authors.lastname: Park
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Public Health, Chonnam National University Medical School, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Public Health, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: In Hyae
authors.initials: IH
authors.lastname: Park
authors.affiliation: Department of Public Health, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Jin Soo
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Public Health, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Jung Ae
authors.initials: JA
authors.lastname: Rhee
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: In Soo
authors.initials: IS
authors.lastname: Kim
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Min Cheol
authors.initials: MC
authors.lastname: Kim
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000517:prevention & control*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000111:Acetylcysteine
keywords: Myocardial infarction; N-acetylcysteine; Nephropathy; Statin