Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast–induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Park, Soo Hwan; Jeong, Myung Ho; Park, In Hyae; Choi, Jong Soo; Rhee, Jung Ae; Kim, In Soo; Kim, Min Cheol; Cho, Jae Yeong; Sim, Doo Sun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

doi:10.1016/j.ijcard.2016.03.009

Cited by 18 publications

(24 citation statements)

References 39 publications

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“…However, clinically relevant results were not obtained. Park et al [23] evaluated 334 STEMI patients in a prospective trial in four groups; low dose statin, high dose statin, high dose statin plus NAC, and high dose statin plus NAC plus NaHCO. They showed CIN in 21.6% of subjects, and high-dose statin plus NAC was related to lower occurrence of CIN in STEMI patients who had undergone primary PCI compared to statin only.…”

Section: Discussionmentioning

confidence: 99%

Comparison of atorvastatin and rosuvastatin on preventing contrast-induced-nephropathy in patients undergoing primary percutaneous coronary intervention: A multi-centric randomized triple-blind clinical trial

2020

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Background: Patients with Contrast-Induced-Nephropathy (CIN) are at a greater risk of in-hospital complications, longer hospitalization, and long-term mortality in comparison with those without CIN. Despite many studies on the helpful effects of statins in preventing contrast-nephropathy, there is not enough evidence comparing different statins in inhibiting CIN. So, we planned this study to compare the efficacy of rosuvastatin and atorvastatin in prevention of contrast-induced nephropathy. Methods: This was a randomized clinical trial. The efficacy of two known statins, atorvastatin and rosuvastatin were compared in prevention of CIN in patients with ST-Elevation Myocardial Infarction (STEMI) who underwent Primary Percutaneous Intervention (PPCI) between May 2015 and April 2016 in Qaem and Imam Reza hospital, Mashhad, Iran. Subjects were divided randomly to 80-mg atorvastatin or 40-mg rosuvastatin group before PPCI. Participants’ characteristics including echocardiographic, laboratory and demographic data were recorded and incidence of CIN was assessed. Results: Two hundred cases with STEMI undergoing PPCI were recruited in the study and randomized to 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) group before PPCI. The incidence of CIN was 5.67% (n = 13) in all participants; 6.3% (n = 7) in the rosuvastatin group and 5.1% (n = 6) in the atorvastatin group. There was a significant difference between creatinine and Glomerular Filtration Rate (GFR) after 48 hours of PPCI. Creatinine was lower and GFR was higher in the rosuvastatin group (P = 0.029, P = 0.005). Conclusion: There was a little trend for prevention of CIN in patients after PPCI in rosuvastatin group compared to atorvastatin group, in full dose. However, this preference was not clinically relevant.

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Section: Discussionmentioning

confidence: 99%

Comparison of atorvastatin and rosuvastatin on preventing contrast-induced-nephropathy in patients undergoing primary percutaneous coronary intervention: A multi-centric randomized triple-blind clinical trial

2020

Signa Vitae

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“…The pleiotropic effect of statins play an important role not only in lowering high lipid levels and stabilizing atherosclerotic plaques, but also in the prevention of kidney damage induced by contrast. 22 N-acetylcysteine, which has antioxidant and vasodilatory properties, has also been found to be an effective strategy to prevent CI-AKI. 22,23 A practical approach to prevent CI-AKI after angiography and vascular procedures should include (1) avoiding dehydration, diuretic on the day of surgery; (2) using isotonic contrast and as low a volume as possible; (3) using N-acetylcysteine and statins if possible; (3) avoiding non-steroidal anti-inflammatory drugs for long-term post-operative pain; and (4) early diagnosis and treatment of sepsis with appropriate antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…22 N-acetylcysteine, which has antioxidant and vasodilatory properties, has also been found to be an effective strategy to prevent CI-AKI. 22,23 A practical approach to prevent CI-AKI after angiography and vascular procedures should include (1) avoiding dehydration, diuretic on the day of surgery; (2) using isotonic contrast and as low a volume as possible; (3) using N-acetylcysteine and statins if possible; (3) avoiding non-steroidal anti-inflammatory drugs for long-term post-operative pain; and (4) early diagnosis and treatment of sepsis with appropriate antibiotics. 4,11 Most patients who develop CI-AKI post-operatively are not seen by a nephrologist, and involving a nephrologist may be appropriate, even if kidney function has partially improved.…”

Section: Discussionmentioning

confidence: 99%

Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia

Zlatanović¹,

Končar

Dragaš

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…It can also decrease the acute kidney injury caused by renal toxic drugs, which can reduce the incidence of CIN. [31,32] …”

Section: Discussionmentioning

confidence: 99%

Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency

Lü

et al. 2017

Medicine

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Background:With the continuous development of cardiac interventional medicine, the incidence of contrast-induced nephropathy (CIN) is increasing every year, which is a serious threat to people's physical and mental health. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can significantly reduce the incidence of CIN. At present, a systematic review and meta-analysis was conducted to evaluate the clinical effect of TMZ on prevention of CIN in patients with renal insufficiency. However, the study did not include patients from other countries and speaking different languages. So we conducted this study to update the previous meta-analysis that investigated the effects of TMZ on prevention of CIN in patients with renal insufficiency, and provided some theoretical reference for clinical.Methods:By searching PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, VIP database, and Wang Fang database for randomized controlled trial, which is comparing TMZ versus conventional hydration for prevention of CIN. Two researchers independently screened literature, and then evaluated the quality of literature and extracted the relevant data. Stata 11.0 software was used for statistical analysis.Results:Finally, this updated review showed that 3 studies that were not included in the previous meta-analysis were included in our study (3 articles were published in the Chinese Journal, 1 study for CIN, 1 study for CIN, serum creatinine (Scr), and superoxide dismutase, 1 study for CIN and Scr), and 1 outcome (Scr) reflecting the change of renal function was additionally included in our study. Of the 932 studies, 6 randomized controlled trials met the criteria, including 377 patients in TMZ group and 387 patients in control group. This meta-analysis for all studies showed that TMZ can significantly reduce the incidence of CIN (relative risk 0.27, 95% confidence interval [CI] 0.16, 0.46, P = 0.000), and can decrease the level of Scr after operation, including Scr of postoperative 24 hours (standardized mean difference [SMD] −0.30, 95% CI −0.51, −0.09, P = 0.005), Scr of postoperative 48 hours (SMD −0.66, 95% CI −1.23, −0.10, P = 0.022), and Scr of postoperative 7 days (SMD −0.74, 95% CI −1.36, −0.11, P = 0.021). However, the Scr of postoperative 72 hours between TMZ group and control group has no statistical significance (P = 0.362).Conclusion:Our study showed that when comparing with conventional hydration, TMZ can significantly reduce the incidence of CIN and the level of postoperative Scr. Therefore, we could suggest that TMZ was superior to conventional hydration for the treatment of CIN in patients with renal insufficiency. However, due to the restriction of quality and number of included articles, it still needs to carry out multicenter, randomized, double-blind clinical trials to confirm this conclusion in the future.

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Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast–induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Cited by 18 publications

References 39 publications

Comparison of atorvastatin and rosuvastatin on preventing contrast-induced-nephropathy in patients undergoing primary percutaneous coronary intervention: A multi-centric randomized triple-blind clinical trial

Comparison of atorvastatin and rosuvastatin on preventing contrast-induced-nephropathy in patients undergoing primary percutaneous coronary intervention: A multi-centric randomized triple-blind clinical trial

Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia

Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency

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