ISCHAEMIC HEART DISEASE

N-acetylcysteine and nephropathy ▸

Patients with acute myocardial infarction undergoing primary angioplasty are at high risk for contrast medium induced nephropathy because of haemodynamic instability and the need for a high volume of contrast medium. N-acetylcysteine (NAC) has been tested in elective percutaneous coronary intervention and may prevent nephropathy. A total of 354 consecutive patients undergoing primary angioplasty were randomised to one of three groups: 116 patients were assigned to a standard dose of NAC (a 600 mg intravenous bolus before primary angioplasty and 600 mg orally twice daily for the 48 hours after angioplasty), 119 patients to a double dose of NAC (a 1200 mg intravenous bolus and 1200 mg orally twice daily for the 48 hours after intervention), and 119 patients to placebo. The serum creatinine concentration increased 25% or more from baseline after primary angioplasty in 39 of the control patients (33%), 17 of the patients receiving standard dose NAC (15%), and 10 patients receiving high dose NAC (8%, p < 0.001). Overall in-hospital mortality was higher in patients with contrast medium induced nephropathy than in those without such nephropathy (26% v 1%, p < 0.001). Thirteen patients (11%) in the control group died, as did five (4%) in the standard dose …