Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty

Droppa, Michal; Desch, Steffen; Blase, Patrick; Eitel, Ingo; Fuernau, Georg; Schuler, Gerhard; Adams, Volker; Thiele, Holger

doi:10.1007/s00392-011-0338-8

Cited by 32 publications

(26 citation statements)

References 40 publications

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“…The primary outcome, CIN, was predominantly defined as a relative increase in sCr concentration of >25% or as an absolute increase in sCr concentration >0.5 mg/dL from baseline within 72 hours after PCI. One of the included trials defined renal dysfunction as an increase in serum cystatin C. 9 N-acetylcysteine. Six of the included studies evaluated the effect of NAC in the prevention of CIN.…”

Section: Resultsmentioning

confidence: 99%

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Busch

Jensen

Rosenberg

et al. 2012

J Interven Cardiology

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Objective:To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac catheterization. CIN is associated with increased risk of cardiac adverse events and mortality, and recent studies point at the risk of developing a transient or persistent renal dysfunction. Patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention have a markedly increased risk of developing CIN. At present no strategy is universally accepted in the prevention of CIN in the acute setting of primary percutaneous coronary intervention. Method: We performed a systematic search in Pubmed and EMBASE and ended up including nine randomised clinical trials; six studies of N-acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further studies are needed before any prevention strategy against CIN can be recommended in routine care of patients undergoing primary percutaneous coronary intervention for STEMI. (J Interven Cardiol 2013;26:97-105) Address for reprints: Sarah Busch, Ved Kløvermarken 9, 2.th, events, prolonged hospitalization, and short-and longterm mortality. 1-3 Patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) have an increased risk of developing CIN when compared with patients undergoing elective PCI. 4,5 Conditions such as hemodynamic instability and impaired systemic perfusion caused by left ventricular dysfunction, large volume of contrast medium, renal hypotension and lack of hydration or other effective prophylactic measures may contribute to the development of renal dysfunction. 4,5 CIN was previously considered a reversible form of acute kidney injury. However, a recent study showed An increase in serum cystatin C concentration of >25% from baseline within 72 hours after PCI.

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Section: Resultsmentioning

confidence: 99%

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Busch

Jensen

Rosenberg

et al. 2012

J Interven Cardiology

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“…Second, since we used creatinine level as indicator of renal insufficiency, the low incidence of CIN were reported than other study. While, several study proposed cystatin C are more reliable for detecting contrast-induced nephropathy [28][29][30][31]. On the other hands, the median volume of contrast used was 100 mL, whereas majority of previous studies use greater volume of contrast media like 300 mL [4,13,31,32].…”

Section: Discussionmentioning

confidence: 93%

Contrast-Induced Nephropathy in Patients Undergoing Elective Coronary Angiography: Incidence and Risk Factors

Salari¹,

Mirbolouk²,

Shad³

et al. 2016

JHS

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Contrast-Induced Nephropathy (CIN) is a considerable complication in cardiac procedures. Several conditions for CIN have been identified after Coronary Angiography (CA). The purpose of this study was to assess the incidence and clinical predictors of CIN 24 h after Coronary Angiography. A total of 1,137 consecutive patients with coronary artery syndrome undergoing CA were prospectively enrolled the study. Serum creatinine (Cr) at baseline and 24 h after CA, as well as demographic and clinical characteristics of patients were measured. Contrast-induced nephropathy was defined as a rise in Cr _0.3 mg/dL after CA. Univariable and multivariable logistic regression analysis were performed to identify independent predictors of CIN. The overall incidence rate was 56 (4.9%) in total study population. In multivariate analysis, baseline Cr > 1.5 (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.04 to 8.3; P < 0.001), Contrast volume > 100 mmL (OR 3.4, 95% CI 0.7 to 8.1; P < 0.002), Baseline GFR < 30 (OR 14.2, 95% CI 8-2; P < 0.000); Baseline GFR 30-60 (OR 8.7, 95% CI 2.3 13.8; P < 0.000) were predictors for CIN. CIN was more frequent in older patients, with higher serum creatinine level and Grater usage of contrast media and diuretic. N-acetylcysteine (NAC) and hydration cannot prevent the occurrence of CIN.

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“…The use of serum creatinine as a marker of renal function has its limitations. Indicators such as the estimated glomerular filtration rate (eGFR) and cystatin C are increasingly considered to be more reliable and accurate reflectors of existing renal function [35,36] and AKIN criteria [30] are insensitive to CNI that develops late during the post PCI period.…”

Section: Limitationmentioning

confidence: 99%

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Martins¹,

Oliveira²,

Mattos³

2017

Interventional-Cardiology.

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Background:Statins may reduce the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). However, there is no knowledge that PCI performed at the same time of statin peak concentration in the blood, may cause additional benefit in renal protection. Methods:This study sought to determine whether PCI realized within the time of rosuvastatin peak concentration was associated with reduced in-hospital CIN compared with standard clinical practice. This single-center prospective, randomized, open-label, non-blinded clinical trial evaluated stable coronary artery disease patients taking chronic statin undergoing PCI. Patients were randomized to receive a loading dose of rosuvastatin (40 mg within 2 to 6 h before angioplasty) or to standard practice (without load dose of rosuvastatin). The pre-specified primary endpoint was the occurrence of CIN defined as an increase in the serum creatinine by {greater than or equal to} 0.3 mg/dl within 24 h after intervention. Contrast-induced nephropathy after coronary angioplasty by creatinine-kinase measure. This trial is registered with (Creatine Leak After Rosuvastatin in Percutaneous Coronary Intervention [CLEAR-PCI]; (ClinicalTrials.gov number: NCT01968577). Results:Of the 544 patients in the main trial, 528 participated in the CLEAR-CIN-PCI substudy, and 493 patients (244 in the rosuvastatin group and 249 in control) were analyzed. CIN occurred in 6 patients of the 244 patients (2.5%) treated with rosuvastatin compared with 9 of the 249 patients (3.6%) in control group (risk ratio, 0.80; 95% confidence interval [CI], 0.42 to 1.50; P=0.455). Conclusion:This result does not support the initiation of rosuvastatin before elective PCI to prevent CIN in patients taking chronic statin therapy.

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Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty

Abstract: High-dose N-ACC does not provide additional benefit over placebo with respect to Cys-C defined CIN in STEMI patients undergoing primary PCI. The magnitude of increase in Cys-C serum levels in the early course after STEMI is a predictor of medium-term MACE.

Cited by 32 publications

References 40 publications

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Contrast-Induced Nephropathy in Patients Undergoing Elective Coronary Angiography: Incidence and Risk Factors

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

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