Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Int J Cardiol. 2016 Jun 1;212:100-6. doi: 10.1016/j.ijcard.2016.03.009. Epub 2016 Mar 18.

Abstract

Background: Acute myocardial infarction (AMI) is a risk factor for contrast-induced nephropathy (CIN). We investigated whether pretreatment with statin, N-acetylcysteine (NAC) and sodium bicarbonate (NaHCO3) reduces the risk of CIN.

Methods: We conducted a prospective trial and enrolled a total of 334 ST-segment elevation myocardial infarction (STEMI) patients. Patients were divided into four groups: Group I (statin 40mg), Group II (statin 80mg), Group III (statin 80mg plus NAC 1200mg) and Group IV (regimen of group III plus NaHCO3 154mEq/L). CIN was defined as ≥25% or ≥0.5mg/dL increase in serum creatinine from the baseline within the 72h after PCI.

Results: CIN occurred in 72 (21.6%) patients. The incidence of CIN was the lowest in the group III (14.3%), and multivariate analysis showed the lower incidence of CIN in group III compared to Group I [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.13-0.64, p=0.002]. Admission hyperglycemia [(AHG)>198mg/dL] (OR 2.20, 95% Cl 1.20-3.68, p=0.011) and the use of intra-aortic balloon pump (IABP) (OR 4.20, 95% CI 1.38-12.78, p=0.016) were independent predictors for CIN. The CIN (OR 9.00, 95% CI 1.30-62.06, p=0.026) was an independent predictor for in-hospital mortality.

Conclusions: Combination of high-dose statin plus NAC was associated with lower incidence of CIN in patients with STEMI who underwent primary PCI compared to statin only.

Keywords: Myocardial infarction; N-acetylcysteine; Nephropathy; Statin.

Publication types

  • Clinical Trial

MeSH terms

  • Acetylcysteine / administration & dosage*
  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / diagnostic imaging
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Contrast Media / adverse effects*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / adverse effects*
  • Prospective Studies
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / drug therapy*
  • ST Elevation Myocardial Infarction / surgery
  • Treatment Outcome

Substances

  • Contrast Media
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Acetylcysteine