Document Detail


N-acetylcysteine and contrast-induced nephropathy in primary angioplasty.
MedLine Citation:
PMID:  16807414     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with acute myocardial infarction undergoing primary angioplasty are at high risk for contrast-medium-induced nephropathy because of hemodynamic instability, the need for a high volume of contrast medium, and the lack of effective prophylaxis. We investigated the antioxidant N-acetylcysteine for the prevention of contrast-medium-induced nephropathy in patients undergoing primary angioplasty. METHODS: We randomly assigned 354 consecutive patients undergoing primary angioplasty to one of three groups: 116 patients were assigned to a standard dose of N-acetylcysteine (a 600-mg intravenous bolus before primary angioplasty and 600 mg orally twice daily for the 48 hours after angioplasty), 119 patients to a double dose of N-acetylcysteine (a 1200-mg intravenous bolus and 1200 mg orally twice daily for the 48 hours after intervention), and 119 patients to placebo. RESULTS: The serum creatinine concentration increased 25 percent or more from baseline after primary angioplasty in 39 of the control patients (33 percent), 17 of the patients receiving standard-dose N-acetylcysteine (15 percent), and 10 patients receiving high-dose N-acetylcysteine (8 percent, P<0.001). Overall in-hospital mortality was higher in patients with contrast-medium-induced nephropathy than in those without such nephropathy (26 percent vs. 1 percent, P<0.001). Thirteen patients (11 percent) in the control group died, as did five (4 percent) in the standard-dose N-acetylcysteine group and three (3 percent) in the high-dose N-acetylcysteine group (P=0.02). The rate for the composite end point of death, acute renal failure requiring temporary renal-replacement therapy, or the need for mechanical ventilation was 21 (18 percent), 8 (7 percent), and 6 (5 percent) in the three groups, respectively (P=0.002). CONCLUSIONS: Intravenous and oral N-acetylcysteine may prevent contrast-medium-induced nephropathy with a dose-dependent effect in patients treated with primary angioplasty and may improve hospital outcome. (ClinicalTrials.gov number, NCT00237614[ClinicalTrials.gov]).
Authors:
Giancarlo Marenzi; Emilio Assanelli; Ivana Marana; Gianfranco Lauri; Jeness Campodonico; Marco Grazi; Monica De Metrio; Stefano Galli; Franco Fabbiocchi; Piero Montorsi; Fabrizio Veglia; Antonio L Bartorelli
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  354     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-29     Completed Date:  2006-07-06     Revised Date:  2007-03-16    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2773-82     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2006 Massachusetts Medical Society.
Affiliation:
Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00237614
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MeSH Terms
Descriptor/Qualifier:
Acetylcysteine / administration & dosage,  therapeutic use*
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Contrast Media / adverse effects*
Creatinine / blood
Female
Humans
Kidney Diseases / chemically induced,  mortality,  prevention & control*
Kidney Failure, Acute / chemically induced,  prevention & control
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / therapy
Chemical
Reg. No./Substance:
0/Contrast Media; 60-27-5/Creatinine; 616-91-1/Acetylcysteine
Comments/Corrections
Comment In:
N Engl J Med. 2006 Oct 5;355(14):1498; author reply 1499-500   [PMID:  17024739 ]
N Engl J Med. 2006 Oct 5;355(14):1497-8; author reply 1499-500   [PMID:  17021328 ]
N Engl J Med. 2006 Oct 5;355(14):1498-9; author reply 1499-500   [PMID:  17024740 ]
N Engl J Med. 2006 Oct 5;355(14):1499; author reply 1499-500   [PMID:  17024738 ]
ACP J Club. 2006 Nov-Dec;145(3):63   [PMID:  17080975 ]
Nat Clin Pract Nephrol. 2007 Jan;3(1):10-1   [PMID:  17183254 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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