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Acetylcysteine Prevents Renal Problems After Angiography: Presented at ACC

By Jill Stein

ATLANTA, GA -- March 18, 2002 -- Prophylactic use of acetylcysteine prevents reduction of renal function after coronary angiography, according to results reported here at the 51^st Annual Scientific Session of the American College of Cardiology (ACC).

Researchers from the Geisinger Medical Center, in Danville, Pennsylvania, also demonstrated that the benefit was greater in patients with baseline serum creatinine levels that were 2 mg/dL or greater.

Transient renal insufficiency after exposure to radiocontrast agents has been well described, and the only preventive measure that has been validated in the setting of coronary angiography is pre- and post-procedure hydration, Dr. Elie Mouhayar explained.

Acetylcysteine has been shown to have clinical benefit in preventing radiocontrast-induced nephropathy if administered orally for 24 hours before and after computed tomography scan studies. Patients undergoing cardiac catheterization receive on average a higher volume of contrast agent and have variable hemodynamic conditions, he said. Accordingly, his group studied the potential benefit of oral acetylcysteine in preventing renal dysfunction in patients undergoing cardiac catheterization.

Fifty-five consecutive patients receiving three doses of acetylcysteine prior to cardiac catheterization were compared to 55 historical controls. All patients in both groups had a baseline serum creatinine level of 1.2 mg/dL or greater and received intravenous hydration before and after the procedure. Serum creatinine levels at baseline and 48 hours after the procedure were compared.

Changes in creatinine mean values after 48 hours were -0.4 (±0.3) and +0.1 (±0.3) mg/dL for treatment and control groups, respectively (p<0.001). The benefit was larger in patients with baseline creatinine levels higher than 2 mg/dL, at -0.4 (±0.4) compared to +0.5 (±0.3) mg/dL (p<0.001).

The incidence of radiocontrast-induced nephropathy in the acetylcysteine group was significantly lower than in the group receiving hydration only (5 percent vs. 16 percent). In the sub-group of patients with a baseline creatinine level of 2 mg/dL or greater, the incidence was much higher in the control group (5 percent vs. 66 percent).

In the multivariate analysis, only the use of acetylcysteine was predictive of fewer increases in serum creatinine and a lower incidence of radiocontrast-induced nephropathy, Dr. Mouhayar said.

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