CLINICAL STUDY: CARDIAC CATHETERIZATION
Acetylcysteine and contrast agent-associated nephrotoxicity
Carlo Briguori, MD, PhD* ,*,
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 and
Bruno Ricciardelli, MD*
* Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
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.
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Abbreviations and Acronyms
| | CI | | confidence interval | | CrCl | | creatinine clearance | | OR | | odds ratio | | PCI | | percutaneous coronary intervention | | ROC | | receiver operating characteristic |
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