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J Am Coll Cardiol, 2002; 40:298-303
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CARDIAC CATHETERIZATION

Acetylcysteine and contrast agent-associated nephrotoxicity

Carlo Briguori, MD, PhD*{dagger},*, Fiore Manganelli, MD*, Pierfranco Scarpato, MD*, Pietro Paolo Elia, MD*, Bruno Golia, MD*, Guido Riviezzo, MD*, Stefano Lepore, MD*, Mariateresa Librera, MD*, Bruno Villari, MD*, Antonio Colombo, MD, FACC{dagger} and Bruno Ricciardelli, MD*

* Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
{dagger} Laboratory of Interventional Cardiology, "Vita e Salute" University School of Medicine, San Raffaele Hospital, Milan, Italy

Manuscript received December 4, 2001; revised manuscript received March 11, 2002, accepted April 17, 2002.

* Reprint requests and correspondence: Dr. Carlo Briguori, Interventional Cardiology, Clinica Mediterranea, Via Orazio 2, Naples, I-80121, Italy.
cabrig{at}hotmail.com

OBJECTIVES: Prophylactic acetylcysteine along with hydration seems to be better than hydration alone in preventing the reduction in renal function induced by a contrast dye.

BACKGROUND: Contrast media can lead to acute renal failure that may occasionally require hemodialysis.

METHODS: One hundred eighty-three consecutive patients with impairment of renal function, undergoing coronary and/or peripheral angiography and/or angioplasty, were randomly assigned to receive 0.45% saline intravenously and acetylcysteine (600 mg orally twice daily; group A, n = 92) or 0.45% saline intravenously alone (group B, n = 91) before and after nonionic, low-osmolality contrast dye administration.

RESULTS: The baseline serum creatinine concentrations were similar (1.5 ± 0.4 mg/dl in group A vs. 1.5 ± 0.4 mg/dl in group B; p = 0.37). An increase of ≥25% in the baseline creatinine level 48 h after the procedure occurred in 6 (6.5%) of 92 patients in group A and in 10 (11%) of 91 patients in group B (p = 0.22). In the subgroup with a low (<140 ml) contrast dose, renal function deterioration occurred in 5 (8.5%) of 60 patients in group B and in 0 of 60 patients in group A (p = 0.02; odds ratio [OR] 0.44, 95% confidence interval [CI] 0.35 to 0.54). In the subgroup with a high contrast dose, no difference was found (5/31 vs. 6/32 patients, p = 0.78). By multivariate analysis, the amount of contrast agent, but not the treatment strategy, was a predictor of the occurrence of contrast dye–associated nephrotoxicity (OR 2.58, 95% CI 1.1 to 4.9; p = 0.035).

CONCLUSIONS: In patients with reduced renal function undergoing angiography and/or angioplasty, the amount of contrast agent, but not the administration of prophylactic acetylcysteine, was a predictor of renal function deterioration. Prophylactic acetylcysteine might provide better protection than hydration alone, only when a small volume of contrast agent is used.

Abbreviations and Acronyms
  CI
  confidence interval
  CrCl
  creatinine clearance
  OR
  odds ratio
  PCI
  percutaneous coronary intervention
  ROC
  receiver operating characteristic




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