Prevention of renal function worsening after coronary angioplasty: The role of acetylcysteine

Recent studies have suggested that oral administration of acetylcysteine could prevent the reduction in renal function induced by radiographic contrast agents in patients with chronic renal failure. Our prospective, controlled, open-label study included 100 consecutive patients with baseline serum creatinine > 1.5 mg/dl and intravenous hydratation who underwent coronary angiography. Baseline and peak post-procedure serum creatinine levels during the following 46 hours were compared in 50 patients with acetylcysteine (600 mg bid, before and after administration of the contrast agent) and 50 patients without acetylcysteine. The baseline clinical characteristics, creatinine levels (Z.l+/-1.2 YS 1 .a+/-0.4 mgldl) and constrast volume (171+/-72 vs 162+/-63 ml) of the 2 groups were similar. The mean changes in creatinine after 24 and 46 hours were -O.l+/-0.2 and O+/0.3 mgldl in the acetylcysteine group vs O+/-0.2 and 0~1-0.4 mgidl in the control group (NS). A contrast-agent-induced renal dysfunctioq, defined as 25% increase in creatinine levels, occurred in 2 patients of the acetylcysteine group and 2 patients of the control group. Conclusions : A contrast-agent-induced renal dysfunction is rare in patients with intravenous hydratation and low volumes of contrast-agent. Our study does not confirm the prophylactic effect of acetylcysteine in the prevention of contrast-agent-induced reduction in renal function after coronary angiography.