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J Am Coll Cardiol, 2002; 40:1383-1388
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CARDIAC CATHETERIZATION

Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure

Kou-G. i Shyu, MD, PhD, FACC*,*, Jun-Jack Cheng, MD, PhD* and Peiliang Kuan, MD, FACC*

* Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Manuscript received May 2, 2002; revised manuscript received June 10, 2002, accepted June 24, 2002.

* Reprint requests and correspondence: Dr. Kou-Gi Shyu, Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen-Chang Road, Taipei 111, Taiwan.
shyukg{at}ms12.hinet.net

OBJECTIVES: We sought to evaluate the efficacy of the antioxidant acetylcysteine in limiting the nephrotoxicity after coronary procedures.

BACKGROUND: The increasingly frequent use of contrast-enhanced imaging for diagnosis or intervention in patients with coronary artery disease has generated concern about the avoidance of contrast-induced nephrotoxicity (CIN). Reactive oxygen species have been shown to cause CIN.

METHODS: We prospectively studied 121 patients with chronic renal insufficiency (mean [±SD] serum creatinine concentration 2.8 ± 0.8 mg/dl) who underwent a coronary procedure. Patients were randomly assigned to receive either acetylcysteine (400 mg orally twice daily) and 0.45% saline intravenously, before and after injection of the contrast agent, or placebo and 0.45% saline. Serum creatinine and blood urea nitrogen were measured before, 48 h and 7 days after the coronary procedure.

RESULTS: Seventeen (14%) of the 121 patients had an increase in their serum creatinine concentration of at least 0.5 mg/dl at 48 h after administration of the contrast agent: 2 (3.3%) of the 60 patients in the acetylcysteine group and 15 (24.6%) of the 61 patients in the control group (p < 0.001). In the acetylcysteine group, the mean serum creatinine concentration decreased significantly from 2.8 ± 0.8 to 2.5 ± 1.0 mg/dl (p < 0.01) at 48 h after injection of the contrast medium, whereas in the control group, the mean serum creatinine concentration increased significantly from 2.8 ± 0.8 to 3.1 ± 1.0 mg/dl (p < 0.01).

CONCLUSIONS: Prophylactic oral administration of the antioxidant acetylcysteine, along with hydration, reduces the acute renal damage induced by a contrast agent in patients with chronic renal insufficiency undergoing a coronary procedure.

Abbreviations and Acronyms
  BUN
  blood urea nitrogen
  CAD
  coronary artery disease
  CIN
  contrast-induced nephropathy
  CrCl
  creatinine clearance
  PCI
  percutaneous coronary intervention




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