Comparison of high dose N-Acetyl cysteine vs. low dose N-acetyl cysteine for prevention of contrast induced nephropathy in patients undergoing Coronary Intervention

Abstract

Objective:To compare the incidence of contrast induced nephropathy in patients undergoing percutaneous angiography or angioplasty receiving placebo vs 600mg, 1200mg and 1800mg of N-acetyl cysteine for prevention.
Methodology: Randomized controlled trial at Pakistan Institute of Medical Sciences, Department of  Cardiology from August 2023 to January 2024. 126 patients were enrolled aged 18 90 years undergoing any percutaneous cardiology with contrast medium Lobitridol
350mg/ml. Allocation to one of four groups with 32 participants in Group A, 34 in Group B and C and 26 participants in Group D. Group A patients received hydration with normal saline at 60ml/hr 24 hours pre and post procedure. Group B patients  received hydration along with 600mg oral NAC twice a day pre and on the day of the procedure. Similarly group C and D received hydration and 1200mg and 1800mg NAC respectively twice a day 24 hours prior to procedure and on day of procedure. Contrast induced nephropathy was identified as absolute rise in the level of serum creatinine of ?0.5mg/dl or more than 25% from baseline or fall in estimated glomerular filtration rate (eGFR) by ?25%, 48h after contrast administration.
Results: Incidence of contrast induced nephropathy at 24 hours was 25% for hydration alone; 17.6%, 8.8% and 11.5% for 600mg, 1200mg and 1800mg doses of NAC with hydration. At 72 hours post procedure the incidence of CIN was 18.8% for hydration alone, 26.4%, 17.6%, and 7.69% for NAC doses of 600mg, 1200mg and 1800mg. No significant association was found with gender, diabetic status, type of procedure, length of procedure or dose of contrast.
Conclusion: Usage of higher doses of NAC may decrease incidence of CIN in patient undergoing coronary procedures with contrast agent. The results of our study can not support the use of NAC nor support abandoning the use of NAC.
Keywords: N-Acetyl cysteine; CIN; Coronary; PCI; Angioplasty