Mohammad G. Saklayen, MD, FACP
Does acetylcysteine reduce risk for contrast-induced acute kidney injury (CI-AKI) in at-risk patients having coronary or peripheral vascular angiography?
Randomized placebo-controlled trial (Acetylcysteine for Contrast-induced nephropathy Trial [ACT]). ClinicalTrials.gov NCT00736866.
Blinded (patients, health care staff, data collectors, and outcome assessors).*
48 to 96 hours and 30 days.
46 sites in Brazil.
2308 patients (mean age 68 y, 62% men) who were having an intravascular angiographic procedure (coronary or peripheral arterial diagnostic angiography or percutaneous intervention) and had ≥ 1 risk factor for CI-AKI: > 70 years of age, chronic renal failure (stable serum creatinine levels > 132.6 µmol/L [1.5 mg/dL]), diabetes mellitus, heart failure, hypotension, or left ventricular ejection fraction < 0.45. Exclusion criteria included dialysis and primary angioplasty after ST-segment elevation myocardial infarction.
Oral acetylcysteine, 1200 mg every 12 hours, given twice before and twice after angiography (n = 1172), or placebo (n = 1136).
CI-AKI (25% increase in serum creatinine level at 48 to 96 h after angiography), composite endpoint of death or need for dialysis, components of the composite endpoint, cardiovascular (CV) death, and adverse events. 2300 patients were needed to detect a 30% relative risk reduction from 15% in CI-AKI at 48 to 96 hours (90% power, 2-tailed α = 0.05).
> 98% (intention-to-treat analysis).
Acetylcysteine did not reduce CI-AKI, all-cause or CV deaths, need for dialysis, or serious adverse events more than placebo (Table). Results for CI-AKI were similar in prespecified subgroups including age > 70 years, sex, serum creatinine level > 132.6 µmol/L (1.5 mg/dL), volume of contrast agent ≥ 140 mL, and presence of diabetes.
In at-risk patients having vascular angiography, acetylcysteine did not reduce risk for contrast-induced acute kidney injury.
†Abbreviations defined in Glossary. RRI, RRR, and CI calculated from data in article.
‡Death (2.0% vs 2.1%, P = 0.92); need for dialysis (0.3% vs 0.3%, P = 0.86).
§Including stroke, myocardial infarction, pneumonia, sepsis, and acute pulmonary edema.
Saklayen MG. Acetylcysteine did not reduce kidney injury in at-risk patients having vascular angiography. Ann Intern Med. ;156:JC1–8. doi: 10.7326/0003-4819-156-2-201201170-02008
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Published: Ann Intern Med. 2012;156(2):JC1-8.
Acute Kidney Injury, Nephrology.
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