Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT)

Circulation. 2011 Sep 13;124(11):1250-9. doi: 10.1161/CIRCULATIONAHA.111.038943. Epub 2011 Aug 22.

Abstract

Background: It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury.

Methods and results: We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P=0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P=0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment.

Conclusions: In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography.

Clinical trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT00736866.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / therapeutic use*
  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Contrast Media / adverse effects*
  • Coronary Angiography / adverse effects*
  • Coronary Angiography / methods
  • Female
  • Humans
  • Kidney Diseases / chemically induced
  • Kidney Diseases / prevention & control
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic / methods
  • Treatment Outcome

Substances

  • Contrast Media
  • Acetylcysteine

Associated data

  • ClinicalTrials.gov/NCT00736866