Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial
Kay, J.; Chow, W.Hing.; Chan, T.Mao.; Lo, S.Kai.; Kwok, O.Hing.; Yip, A.; Fan, K.; Lee, C.Hang.; Lam, W.Fai.
JAMA 289(5): 553-558
2003
ISSN/ISBN: 0098-7484 PMID: 12578487 Document Number: 561863
Context: The antioxidant acetylcysteine prevents acute contrast nephrotoxicity in patients with impaired renal function who undergo computed tomography scanning. However, its role in coronary angiography is unclear. Objective: To determine whether oral acetylcysteine prevents acute deterioration in renal function in patients with moderate renal insufficiency who undergo elective coronary angiography. Design and Setting: Prospective, randomized, double-blind, placebo-controlled trial conducted from May 2000 to December 2001 at the Grantham Hospital at the University of Hong Kong. Participants: Two hundred Chinese patients aged mean (SD) 68 (6.5) years with stable moderate renal insufficiency (creatinine clearance <60 mL/min (1.00 mL/s)) who were undergoing elective coronary angiography with or without intervention. Intervention: Participants were randomly assigned to receive oral acetylcysteine (600 mg twice per day; n=102) or matching placebo tablets (n=98) on the day before and the day of angiography. All patients received low-osmolality contrast agent. Main Outcome Measures: Occurrence of more than a 25% increase in serum creatinine level within 48 hours after contrast administration; change in creatinine clearance and serum creatinine level. Results: Twelve control patients (12%) and 4 acetylcysteine patients (4%) developed a more than 25% increase in serum creatinine level within 48 hours after contrast administration (relative risk, 0.32; 95% confidence interval (CI), 0.10-0.96; P=.03). Serum creatinine was lower in the acetylcysteine group (1.22 mg/dL (107.8 mumol/L); 95% CI, 1.11-1.33 mg/dL vs 1.38 mg/dL (122.9 mumol/L); 95% CI, 1.27-1.49 mg/dL; P=.006) during the first 48 hours after angiography. Acetylcysteine treatment significantly increased creatinine clearance from 44.8 mL/min (0.75 mL/s) (95% CI, 42.7-47.6 mL/min) to 58.9 mL/min (0.98 mL/s) (95% CI, 55.6-62.3 mL/min) 2 days after the contrast administration (P<.001). The increase was not significant in the control group (from 42.1 to 44.1 mL/min (0.70 to 0.74 mL/s); P=.15). The benefit of acetylcysteine was consistent among various patient subgroups and persistent for at least 7 days. There were no major treatment-related adverse events. Conclusion: Acetylcysteine protects patients with moderate chronic renal insufficiency from contrast-induced deterioration in renal function after coronary angiographic procedures, with minimal adverse effects and at a low cost.