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)

被引：256

作者：

Berwanger, Otavio ^{[1
,2
]}

Cavalcanti, Alexandre B. ^{[1
,2
]}

Sousa, Amanda G. M. R. ^{[1
,2
]}

Buehler, Anna M. ^{[1
,2
]}

Kodama, Alessandra A. ^{[1
,2
]}

Carballo, Mariana T. ^{[1
,2
]}

Carvalho, Vitor O. ^{[1
]}

Amodeo, Celso ^{[1
,2
]}

Lotaif, Leda D. ^{[1
,2
]}

Sousa, Jose Eduardo ^{[1
,2
]}

Victor, Elivane S. ^{[2
]}

Santucci, Eliana ^{[2
]}

Cardoso, Carlos E. S. ^{[2
]}

da Silva, Dalmo ^{[2
]}

Mendes, Adailton L. ^{[2
]}

Lobato, Jose ^{[2
]}

Prates, G. ^{[3
]}

Yokoyama, H. ^{[3
]}

Almeida, P. ^{[3
]}

Pessoa, C. ^{[3
]}

Martins, H. ^{[4
]}

Lopes, M. ^{[4
]}

Barros, M. ^{[4
]}

Reis, H. ^{[5
]}

Cordeiro, C. ^{[5
]}

Castello, H. ^{[6
]}

Cantarelli, M. ^{[6
]}

Ferreira, S. ^{[6
]}

Mattos, C. ^{[7
,10
,21
]}

Rati, M. ^{[7
]}

Medeiros, C. ^{[7
]}

Mangione, J. A. ^{[8
]}

Mauro, M. F. ^{[8
]}

Cristovao, S. A. ^{[8
]}

Carnieto, N. M. ^{[8
]}

Rocha, L. C. ^{[8
]}

Maksud, D. F. ^{[8
]}

Barbosa, C. ^{[8
]}

Costantini, C. ^{[9
]}

Tarbine, S. ^{[9
]}

Santos, M. ^{[9
]}

Ortiz, C. ^{[9
]}

Souza, A. ^{[9
]}

Mattos, C. ^{[7
,10
,21
]}

Duarte, L. ^{[10
]}

Marin Neto, J. ^{[11
]}

Figueiredo, G. ^{[11
]}

Lemos, D. ^{[11
]}

Braga, F. ^{[11
]}

Novaes, G. ^{[11
]}

机构：

[1] Hosp Coracao HCor, Res Inst, BR-04005000 Sao Paulo, Brazil

[2] Inst Dante Pazzanese Cardiol, Sao Paulo, Brazil

[3] Associacao Hosp Bauru, Sao Paulo, Brazil

[4] Cardioctr Hosp Santa Paula, Joao Pessoa, Paraiba, Brazil

[5] Fundacao Publ Estadual Hosp Gaspar Vianna, Belem, Para, Brazil

[6] Hosp Bandeirantes, Sao Paulo, Brazil

[7] Hosp Barra Dor, Rio De Janeiro, Brazil

[8] Hosp Beneficencia Portuguesa, Sao Paulo, Brazil

[9] Hosp Cardiol Constantini, Curitiba, Parana, Brazil

[10] Hosp Copa Dor, Rio De Janeiro, Brazil

[11] Univ Sao Paulo, Fac Med Ribeirao Preto, Hosp Clin, Sao Paulo, Brazil

[12] Fac Fed Pernambuco, Hosp Clin, Recife, PE, Brazil

[13] Hosp Terapia Intens HTI, Teresina, Piaui, Brazil

[14] Hosp Coracao Juiz de Fora, Juiz De Fora, MG, Brazil

[15] Hosp Coracao Sao Paulo, Sao Paulo, Brazil

[16] Hosp Coracao Brasil, Brasilia, DF, Brazil

[17] Hosp Escola Alvaro Alvim, Rio De Janeiro, Brazil

[18] Hosp Felicio Rocho, Belo Horizonte, MG, Brazil

[19] Hosp Maternidade Pronto Socorro Santa Lucia, Pocos De Caldas, MG, Brazil

[20] Hosp Moinhos Vento, Porto Alegre, RS, Brazil

[21] Hosp Quinta Dor, Rio De Janeiro, Brazil

[22] Hosp Reg Sul de Minas, Varginha, MG, Brazil

[23] Hosp Samaritano, Sao Paulo, Brazil

[24] Hosp Santa Catarina, Blumenau, SC, Brazil

[25] Hosp Santa Helena Sao Francisco Cardio Vida, Aparecida De Goiania, Go, Brazil

[26] Hosp Santa Lucinda, Sao Paulo, Brazil

[27] Hosp Santa Marcelina, Sao Paulo, Brazil

[28] Hosp Sao Jose Avai, Itaperuna, RJ, Brazil

[29] Hosp SOS Cardio, Florianopolis, SC, Brazil

[30] Hosp UDI, Sao Luis, Maranhao, Brazil

[31] Hosp Univ Sao Jose, Belo Horizonte, MG, Brazil

[32] INCOR Hemocardio, Natal, RN, Brazil

[33] INCORPI Hosp Fornecedores Cana, Sao Paulo, Brazil

[34] Inst Cardiol, Sao Jose, SC, Brazil

[35] Inst Cardiol RGS Fundacao Univ Cardiol, Porto Alegre, RS, Brazil

[36] Juiz de Fora Hosp Monte Sinai, Inst Clin & Cirurgia, Juiz De Fora, MG, Brazil

[37] Inst Molestias Cardiovasc, Sao Paulo, Brazil

[38] Inst Coracao Triangulo Mineiro, Uberlandia, MG, Brazil

[39] Inst Coracao Taguatinga Hosp Anchieta, Taguatinga, DF, Brazil

[40] Inst Nacl Cardiol Laranjeiras, Rio De Janeiro, Brazil

[41] Natal Hosp Ctr, Natal, RN, Brazil

[42] Santa Casa Limeira, Sao Paulo, Brazil

[43] Santa Casa Marilia, Sao Paulo, Brazil

[44] Santa Casa Misericordia Juiz de Fora, Juiz De Fora, MG, Brazil

[45] Santa Casa Porto Alegre, Porto Alegre, RS, Brazil

[46] Santa Casa Sao Paulo, Sao Paulo, Brazil

[47] UNISUL Hosp Socimed, Tubarao, SC, Brazil

来源：

CIRCULATION | 2011年 / 124卷 / 11期

关键词：

acute kidney injury; coronary angiogram; contrast media; angioplasty; acetylcysteine; N-ACETYLCYSTEINE; INTERVENTION; FAILURE; METAANALYSIS; RISK; NEPHROTOXICITY; ASSOCIATION; GUIDELINES; QUALITY; IMPACT;

D O I：

10.1161/CIRCULATIONAHA.111.038943

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1250 / 1259

页数：10

共 44 条

[41] High-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy [J].

Trivedi, Hariprasad ;

Daram, Sumanth ;

Szabo, Aniko ;

Bartorelli, Antonio L. ;

Marenzi, Giancarlo .

AMERICAN JOURNAL OF MEDICINE, 2009, 122 (09) :874.e9-874.e15

[42] A randomized controlled trial of intravenous N-acetylcysteine for the prevention of contrtast-induced nephropathy after cardiac catheterization: Lack of effect [J].

Webb, JG ;

Pate, GE ;

Humphries, KH ;

Buller, CE ;

Shalansky, S ;

Al Shamari, A ;

Sutander, A ;

Williams, T ;

Fox, RS ;

Levin, A .

AMERICAN HEART JOURNAL, 2004, 148 (03) :422-429

[43]

WIJNS W., 2010, European Heart Journal, V31, P2501, DOI DOI 10.1093/EURHEARTJ/EHQ277

[44] N-acetylcysteine and contrast-induced nephropathy:: A meta-analysis of 13 randomized trials [J].

Zagler, A ;

Azadpour, M ;

Mercado, C ;

Hennekens, CH .

AMERICAN HEART JOURNAL, 2006, 151 (01) :140-145

← 1 2 3 4 5 →