A randomized trial of intravenous N-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes

Zehra Jaffery, Anil Verma, Christopher J. White, Arthur G. Grant, Tyrone J. Collins, Mark A. Grise, James S. Jenkins, Paul W. McMullan, Rajan A. Patel, John P. Reilly, Stanley N. Thornton, Stephen R. Ramee

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥25% above the baseline level within 72 hr of the administration of intravenous contrast. Results: There was no difference found for the primary end point with CIN in 16% of the NAC group and in 13% of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). Conclusion: In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.

Original languageEnglish (US)
Pages (from-to)921-926
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume79
Issue number6
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Acetylcysteine
Acute Coronary Syndrome
Percutaneous Coronary Intervention
Placebos
Angiography
Cystatin C
Incidence
Coronary Angiography
Serum
Oxidants
Intravenous Administration
Creatinine
Pharmacokinetics
Kidney
Control Groups

Keywords

  • acute coronary syndrome
  • contrast induced nephropathy
  • intravenous n-acetylcysteine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

A randomized trial of intravenous N-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes. / Jaffery, Zehra; Verma, Anil; White, Christopher J.; Grant, Arthur G.; Collins, Tyrone J.; Grise, Mark A.; Jenkins, James S.; McMullan, Paul W.; Patel, Rajan A.; Reilly, John P.; Thornton, Stanley N.; Ramee, Stephen R.

In: Catheterization and Cardiovascular Interventions, Vol. 79, No. 6, 01.05.2012, p. 921-926.

Research output: Contribution to journalArticle

Jaffery, Z, Verma, A, White, CJ, Grant, AG, Collins, TJ, Grise, MA, Jenkins, JS, McMullan, PW, Patel, RA, Reilly, JP, Thornton, SN & Ramee, SR 2012, 'A randomized trial of intravenous N-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes', Catheterization and Cardiovascular Interventions, vol. 79, no. 6, pp. 921-926. https://doi.org/10.1002/ccd.23157
Jaffery, Zehra ; Verma, Anil ; White, Christopher J. ; Grant, Arthur G. ; Collins, Tyrone J. ; Grise, Mark A. ; Jenkins, James S. ; McMullan, Paul W. ; Patel, Rajan A. ; Reilly, John P. ; Thornton, Stanley N. ; Ramee, Stephen R. / A randomized trial of intravenous N-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes. In: Catheterization and Cardiovascular Interventions. 2012 ; Vol. 79, No. 6. pp. 921-926.
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abstract = "Background: Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥25{\%} above the baseline level within 72 hr of the administration of intravenous contrast. Results: There was no difference found for the primary end point with CIN in 16{\%} of the NAC group and in 13{\%} of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). Conclusion: In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.",
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AU - Grant, Arthur G.

AU - Collins, Tyrone J.

AU - Grise, Mark A.

AU - Jenkins, James S.

AU - McMullan, Paul W.

AU - Patel, Rajan A.

AU - Reilly, John P.

AU - Thornton, Stanley N.

AU - Ramee, Stephen R.

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N2 - Background: Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥25% above the baseline level within 72 hr of the administration of intravenous contrast. Results: There was no difference found for the primary end point with CIN in 16% of the NAC group and in 13% of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). Conclusion: In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.

AB - Background: Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥25% above the baseline level within 72 hr of the administration of intravenous contrast. Results: There was no difference found for the primary end point with CIN in 16% of the NAC group and in 13% of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). Conclusion: In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.

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