Copyright © 2004 by the European Society of Cardiology.
Clinical paper
Oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy following coronary angiography
A randomized controlled trial and review of the current literature
a Heart Institute, Sheba Medical Center, Tel Hashomer, Israel
b Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
* Correspondence to: Victor Guetta, M.D., Heart Institute, Sheba Medical Center, Tel Hashomer 52621, Israel. Tel: +972 3 635 2303; Fax: +972 3 534 3888
E-mail address: guettav{at}netvision.net.il
Received 3 June 2003; revised 10 November 2003; accepted 20 November 2003
Abstract
Aims To determine laboratory and clinical benefit of oral acetylcysteine, as an adjunct to saline hydration, in chronic renal insufficiency patients undergoing coronary angiography.
Methods and results We prospectively studied 80 patients with chronic renal insufficiency (mean [±SD] serum creatinine concentration 2.0±0.39mg/dl), who underwent coronary angiography with or without intervention. Patients were randomly assigned to receive either acetylcysteine (600mg orally t.i.d.) or placebo, in addition to intravenous 0.45% saline (1ml/kg of body weight per hour), 12h prior to and after coronary angiography. There was an increase of 
0.5mg/dl in the serum creatinine concentration 48h after coronary angiography in seven of the 80 patients (9%): in four of the 41 patients (10%) in the acetylcysteine group and in three of the 39 patients (8%) in the placebo group (P=0.52). The incidence of in-hospital adverse clinical events (acetylcysteine, 5% vs placebo, 8%, P=0.47) and the length of hospital stay [acetylcysteine, median (interquartile range) 4 (2–4) days vs placebo, 2 (2–4) days, P=0.44] did not differ significantly between the two treatment groups.
Conclusion Our findings do not support routine prophylactic administration of oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy in chronic renal insufficiency patients undergoing coronary angiography.
Key Words: Acetylcysteine • Coronary angiography • Renal insufficiency • Contrast-nephropathy
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