ACT (Acetylcysteine for Contrast-InducedNephropathy Trial)
ACT (Acetylcysteine for Contrast-InducedNephropathy Trial)O Berwanger (Hospital de Coração, São Paulo, Brazil)American Heart Association 2010 Scientific Sessions• The antioxidant N-acetylcysteine has been used as adjunctive therapy for about 10 years to reduce kidney injury caused by contrast used in coronary and vascular angiography. However, evidence for its use remains conflicting• Population and treatment: 2308 patients undergoing an angiographic procedure Randomized to 1200 mg of N-acetylcysteine, twice daily, with two doses given before the procedure and two doses after the procedure, or to placebo• Outcomes: Primary end point: contrast-induced nephropathy Secondary end points: serum creatinine elevations
ACT: Results• No difference was observed in the primary end point: 12.7% in both groups (RR 1.00; 95% CI, 0.81–1.25)• No difference was observed in the secondary end point: 3.9% for N-acetylcysteine and 3.8% for placebo (serum creatinine elevation >0.5 mg/dL)• No difference was observed in the 30-day clinical end points: Including mortality, the need for dialysis, or CV mortality• A subgroup analysis revealed no benefit in any patient population: Including patients stratified by age, the presence of diabetes mellitus, sex, serum creatinine levels, or type of contrast used prior to angiography
ACT: Commentary*"I would be comfortable saying that this is a definitive trial, and Id be comfortablesaying that because if you look at the other high-quality trials, we reached exactlythe same result." - Dr Otavio Berwanger"I remember being in the cath lab as a cardiology fellow and patients were comingin with N-acetylcysteine, and I remember thinking, What the heck is this drug? Howquickly it was adopted into practice was remarkable." - Dr Brahmajee Nallamothu*All comments from ACT: No benefit of N-acetylcysteine to reduce contrast-induced nephropathy (http://www.theheart.org/article/1151175.do)
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