Abstract 12743: The Role of Combined Treatment With Ascorbic Acid and N-Acetylcysteine in Prevention of Contrast-Induced Nephropathy in High-Risk Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.
Background: Patients with acute myocardial infarction undergoing percutaneous coronary intervention (PCI) are at high-risk of contrast-induced nephropathy. Conflicting evidence suggests that administration of the antioxidant acetylcysteine (NAC) prevents the renal impairment. The action of other antioxidant agents has not been investigated in that setting. The ascorbic acid has been shown to attenuate the renal damage in some studies, however there are no data on the usage of combination of NAC and ascorbic acid especially in patients with acute coronary syndrome.
Objectives: The aim of our study was to examine the role of combined treatment with NAC, ascorbic acid and fluids in comparison to NAC with fluids, and fluids alone for the prevention of contrast induced nephropathy in high-risk patients undergoing primary angioplasty. Material: A prospective, single-center, randomized trial in 152 consecutive patients with acute coronary syndrome and at least one risk factor of contrast nephropathy, undergoing emergency PCI was conducted. Contrast-mediated nephropathy was defined by an absolute increase of serum creatinine ≥0.5mg/dl or relative increase of ≥25% measured 2–5 days after the procedure.
Methods and Results: Patients were randomized to 3 groups. Group A received hydratation (0.9% saline) started just before contrast injection and continued for 12h after PCI. Group B received hydratation and high-dose NAC (1200mg iv before PCI followed by 1200mg orally twice daily for the next 2 days after procedure). Group C received hydratation, high-dose NAC and ascorbic acid (3000 mg iv before PCI followed by 2000mg orally in the night and morning after procedure). Contrast mediated nephropathy occurred in 9 of 52 patients (17.3%) Group A, 7 of 50 patients (14.0%) Group B and 2 of 50 patients (4.0%) Group C (p<0.01). The mean serum creatinine concentration increased significantly in Group A in comparison to Group B and Group C (p<0.01).
Conclusions: Prophylactic administration of high-dose NAC and ascorbic in high-risk patients offers better protection against contrast-mediated nephropathy in high-risk patients with acute coronary syndrome undergoing coronary intervention.
- © 2010 by American Heart Association, Inc.