Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure

Shyu, Kou Gi; Cheng, Jian; Kuan, Peiliang

doi:10.1016/s0735-1097(02)02308-2

Cited by 265 publications

(207 citation statements)

References 28 publications

Supporting

Mentioning

184

Contrasting

Unclassified

Order By: Relevance

“…However, reducing the volume of contrast media within the procedure was found to be the most effective. [10][11][12][13][14] Cigarroa, et al 15 and Freeman, et al 16 both investigated the significance of an adjusted volume of contrast media to patient's body weight and serum creatinine level (maximum radiographic contrast dose (MRCD)) in relation to the occurrence of CIN. CIN developed in 2% of cases when the calculated MRCD for a group of patients was not exceeded, and a 15-fold increase in incidence for a group where MRCD was exceeded.…”

Section: Introductionmentioning

confidence: 99%

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

et al. 2008

View full text Add to dashboard Cite

IntroductionDiagnostic coronary angiography utilises radiographic contrast media to delineate epicardial coronary lesions and assess left ventricular function. While contrast media is essential for the radiographic visualisation of coronary vessels, there are certain risks and complications associated with its use. One such complication is contrast-induced nephropathy (CIN). CIN is a life-threatening dose-dependent reaction and is commonly defined as a decrease in renal function 24-48 hours after contrast media administration, with a rise in serum creatinine levels of more than 25% from the baseline (or an absolute increase greater than 0.5 mg/dL) three to five days after the procedure. [1][2][3][4][5][6][7][8][9] Preventative measures for CIN in cardiovascular procedures include pre-hydration, prophylactic administration of N-acetylcysteine and utilisation of iso-osmolar/hypo-osmolar contrast media. However, reducing the volume of contrast media within the procedure was found to be the most effective. [10][11][12][13][14] Cigarroa, et al. 15 and Freeman, et al. 16 both investigated the significance of an adjusted volume of contrast media to patient's body weight and serum creatinine level (maximum radiographic contrast dose (MRCD)) in relation to the occurrence of CIN. CIN developed in 2% of cases when the calculated MRCD for a group of patients was not exceeded, and a 15-fold increase in incidence for a group where MRCD was exceeded. Similarly Rihal, et al. 12 reported a 12% increase in the risk of nephropathy with each 100 mL administered to the patient. As CIN has been found to be the third leading cause of acute renal failure in patients (10% of all admitted cases), it is essential that contrast load is kept to a minimum in any examinations requiring contrast media. 3,17 Coronary angiography can be performed using either singleplane or biplane imaging equipment. Single-plane imaging involves the use of one x-ray tube to acquire images at different angles and requires a separate injection of contrast for each cine angiography run. Biplane imaging utilises two x-ray tubes and is capable of acquiring two simultaneous projections with a single contrast injection. Therefore, it is assumed that contrast load will not only be reduced, but screening time and overall procedural time will be shorter.In biplane imaging, the screening time is inclusive of the total fluoroscopy and cine angiography time for both planes. The screening time should therefore be shorter for biplane imaging than single-plane imaging as it acquires two images simultaneously. Additionally, as the setup of the two C-arms require less movement throughout the procedure, the use of biplane equipment would accordingly assist in reducing procedural time when compared to single-plane imaging. Furthermore, because the runs are calculated from each individual plane, biplane should result in a slightly greater number of cine angiography runs than single-plane imaging. Where single-plane will complete the nine standard projections, biplane will produce ...

show abstract

Section: Introductionmentioning

confidence: 99%

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

et al. 2008

View full text Add to dashboard Cite

show abstract

“…The success of the procedure depends on previous knowledge of the renal insufficiency condition. Special considerations that should be arranged beforehand include the use of the lowest quantity of contrast agent possible, preferably in doses that do not exceed 2 ml/kg, and the use of nonionic or low osmolality contrast agents, associated with keeping the patient adequately hydrated 11,12 . These renal protection measures were rigorously followed in our patient.…”

Section: Discussionmentioning

confidence: 99%

Estado da arte do procedimento percutâneo: paciente octogenário submetido com sucesso, em apenas uma sessão, a valvotomia pulmonar, implante de stent coronário e implante de marcapasso definitivo

Filho¹,

Neto²,

Cividanis³

et al. 2005

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

This report describes a case involving an 82 year old patient with mild renal insufficiency, severe pulmonary valve stenosis (PVS), severe anterior descending artery stenosis and complete atrioventricular block, who successfully underwent, in a single session, coronary angioplasty and a stent implant, pulmonary valvotomy and a permanent pacemaker implant.Coronary percutaneous interventions with stent implants are extensively used in the treatment of coronary patients, including octogenarians 1-5 . PVS, frequently diagnosed and treated during childhood or adolescence, is rarely found in octogenarian patients. Percutaneous treatment of PVS is a safe and efficient procedure 6 .A cardiac conduction system disease in an octogenarian is common and an indication for a permanent pacemaker implant is frequently recommended.Our report refers to an octogenarian patient with severe PVS, a serious lesion in the mid third of the anterior descending artery and complete atrioventricular block (CAVB). This patient was submitted successfully to three consecutive procedures in the cardiac catheterization laboratory: pulmonary valvotomy, coronary stent implant and permanent pacemaker implant. CASE REPORTThe patient is an 82 year old male in good general condition, with dyspnea for two months, progressively increasing from moderate to mild exertions. A physical examination presented blood pressure (BP) of 150/90 mmHg, cardiac frequency of 60 beats per minute and a systolic ejection murmur ++/4 over the pulmonary area radiating toward the left sternal edge. The chest x-rays show a cardiac silhouette within normal limits, pulmonary vasculature within normal limits, prominent dilation of the pulmonary artery trunk, pulmonary parenchyma within normal limits, blunted cardiophrenic and costophrenic angles. An electrocardiogram, taken ninety days earlier, revealed a sinus rhythm, CF of 60 bpm, SAQRS between 90 and 180 degrees and an increased strain on the right chambers. The laboratory tests presented creatinine levels of 2.3 mg/ml and urea of 60 mg/ml. The echocardiogram revealed severe PVS and an alteration in the left ventricle relaxation phase.The procedure was performed after renal preparation. The patient was adequately hydrated and given 600 mg of N-acetylcysteine every twelve hours, maintaining the drug administration for 48 hours.The hemodynamic study confirmed severe pulmonary valve stenosis with a systolic gradient of 80 mmHg (PT = 20/10 mmHg and RV = 100/8 mmHg). anterior descending artery presented eccentric stenosis, 70% ulcerated in its mid third; the other arteries presented discrete wall motion irregularities. The left ventricle (LV) presented normal contractile function. The renal preparation was performed before the procedure with adequate hydration and previous administration of Nacetylcysteine for 48 hours as well as antiplatelet therapy with ASA and clopidogrel in the normal dosages. There was a reduction in the levels of creatinine and urea to 1 mg/ml and 40 mg/ml, respectively.On the day of the procedure, during ad...

show abstract

“…7 Their findings in 127 patients indicate that acute renal damage was reduced when results were compared with those of patients receiving hydration alone.…”

Section: Contrast Nephropathy or Contrast Creatininopathymentioning

confidence: 99%

Contrast nephropathy or contrast creatininopathy

Conti¹

2003

Clinical Cardiology

View full text Add to dashboard Cite

Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure

Abstract: Prophylactic oral administration of the antioxidant acetylcysteine, along with hydration, reduces the acute renal damage induced by a contrast agent in patients with chronic renal insufficiency undergoing a coronary procedure.

Cited by 265 publications

References 28 publications

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

Estado da arte do procedimento percutâneo: paciente octogenário submetido com sucesso, em apenas uma sessão, a valvotomia pulmonar, implante de stent coronário e implante de marcapasso definitivo

Contrast nephropathy or contrast creatininopathy

Contact Info

Product

Resources

About