Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial.

摘要: ContextThe 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.ObjectiveTo determine whether oral deterioration in moderate insufficiency undergo elective angiography.Design and SettingProspective, randomized, double-blind, placebo-controlled trial conducted from May 2000 to December 2001 at the Grantham Hospital University of Hong Kong.ParticipantsTwo hundred Chinese aged mean (SD) 68 (6.5) years stable moderate (creatinine clearance <60 mL/min [1.00 mL/s]) who were undergoing elective or without intervention.InterventionParticipants randomly assigned receive acetylcysteine(600 mg twice per day; n = 102) matching placebo tablets (n 98) on day before day of angiography. All received low-osmolality contrast agent.Main Outcome MeasuresOccurrence more than a 25% increase serum creatinine level within 48 hours after administration; change and serum level.ResultsTwelve control (12%) 4 (4%) developed a within 48 contrast administration (relative risk, 0.32; 95% confidence interval [CI], 0.10-0.96; P .03). Serum was lower acetylcysteine group (1.22 mg/dL [107.8 µmol/L]; CI, 1.11-1.33 vs 1.38 mg/dL [122.9 1.27-1.49 mg/dL; = .006) during first Acetylcysteine treatment significantly increased from 44.8 (0.75 mL/s) (95% 42.7-47.6 mL/min) 58.9 (0.98 mL/s) (95% 55.6-62.3 mL/min) 2 days administration (P<.001).The increase not significant group (from 42.1 44.1 mL/min [0.70 0.74 mL/s]; .15). The benefit acetylcysteine was consistent among various patient subgroups persistent for least 7 days. There no major treatment-related adverse events.ConclusionAcetylcysteine protects chronic insufficiency from contrast-induced deterioration angiographic procedures, minimal effects low cost.