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Contemporary use and effectiveness of n-acetylcysteine in preventing contrast-induced nephropathy among patients undergoing percutaneous coronary intervention
JACC - Journal of the American College of Cardiology: Cardiovascular Interventions, 01/19/2012
Clinical Article
Gurm HS et al. – Use of N–acetylcysteine (NAC) is common and has steadily increased over the study period but does not seem to be associated with improved clinical outcomes in real–world practice.
Methods- Use of NAC was assessed in consecutive patients undergoing nonemergent percutaneous coronary intervention from 2006 to 2009 in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, a large multicenter quality improvement collaborative.
- Authors examined the overall prevalence of NAC use in these patients and then used propensity matching to link its use with clinical outcomes, including CIN, nephropathy–requiring dialysis, and death.
- Of the 90,578 percutaneous coronary interventions performed during the study period, NAC was used in 10,574 (11.6%) procedures, with its use steadily increasing over the study period.
- Patients treated with NAC were slightly older and more likely to have baseline renal insufficiency and other comorbidities.
- In propensity–matched, risk–adjusted models, authors found no differences in outcomes between patients treated with NAC and those not receiving NAC for CIN (5.5% vs. 5.5%, p = 0.99), nephropathy–requiring dialysis (0.6% vs. 0.6%, p = 0.69), or death (0.6% vs. 0.8%, p = 0.15).
- These findings were consistent across many prespecified subgroups.
