July 10, 2006
By
Sahar
Bedrood B.S. and Asher Kimchi M.D.
Milan, Italy
- Patients with acute myocardial infarction
undergoing primary angioplasty are at high risk for
contrast-medium-induced nephropathy. Giancarlo
Marenzi M.D. et al from the Institute of Cardiology
at the University of Milan investigated the use of
N-acetylcysteine for the prevention of
contrast-medium-induced nephropathy in patients
undergoing primary angioplasty. The study, published
in the June 29,2006 issue of The New England Journal
of Medicine, concluded that intravenous and oral N-acetylcysteine
may prevent contrast-medium-induced nephropathy with
a dose-dependent effect in patients treated with
primary angioplasty and may improve hospital
outcome.
The study randomly assigned 354 consecutive patients
undergoing primary angioplasty to one of three
groups: 116 patients were assigned to a standard dose
of N-acetylcysteine (a 600-mg intravenous
bolus before primary angioplasty and 600 mg orally twice daily
for the 48 hours after angioplasty), 119 patients to a
double dose of N-acetylcysteine (a 1200-mg
intravenous bolus and 1200 mg orally twice daily for
the 48 hours after intervention), and 119 patients to
placebo.
Their results indicated that the serum creatinine
concentration increased 25 percent or more from
baseline after primary angioplasty in 39 of the
control patients (33 percent), 17 of the patients receiving
standard-dose N-acetylcysteine (15 percent), and 10
patients receiving high-dose N-acetylcysteine
(8 percent, P<0.001). Overall in-hospital mortality
was higher in patients with contrast-medium–induced
nephropathy than in those without such nephropathy (26 percent
vs. 1 percent, P<0.001). Thirteen patients (11 percent) in
the control group died, as did five (4 percent) in the
standard-dose N-acetylcysteine group and three
(3 percent) in the high-dose N-acetylcysteine
group (P=0.02). The rate for the composite end point
of death, acute renal failure requiring temporary
renal-replacement therapy, or the need for mechanical
ventilation was 21 (18 percent), 8 (7 percent), and 6
(5 percent) in the three groups, respectively
(P=0.002).
Intravenous and oral N-acetylcysteine may prevent
contrast-medium–induced nephropathy with a dose-dependent
effect in patients treated with primary angioplasty and
may improve hospital outcome.
Co-authors: Giancarlo Marenzi, M.D., Emilio Assanelli, M.D.,
Ivana Marana, M.D., Gianfranco Lauri, M.D., Jeness Campodonico,
M.D., Marco Grazi, M.D., Monica De Metrio, M.D., Stefano Galli,
M.D., Franco Fabbiocchi, M.D., Piero Montorsi, M.D., Fabrizio
Veglia, Ph.D., and Antonio L. Bartorelli, M.D.
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