N-acetylcysteine prevented contrast-medium-induced nephropathy in primary angioplasty.

M e t h o d s Design: Randomized placebo-controlled trial. Allocation: Unclear allocation concealment.* Blinding: Blinded (study investigators involved in the procedures).* Follow-up period: Up to hospital discharge. Setting: A coronary care unit in Centro Cardiologico Monzino, Milan, Italy. Patients: 354 patients (mean age 62 y, 81% men) who received primary angioplasty for ST-elevation myocardial infarction within 12 hours (18 h for cardiogenic shock) after onset of symptoms. Exclusion criteria were longterm dialysis and allergy to NAC. Intervention: Standard dose NAC (n = 116), high-dose NAC (n = 119), or placebo (n = 119). The standard-dose group received an intravenous (IV) bolus of NAC, 600 mg, before angioplasty plus a 600-mg tablet, orally twice daily for 48 hours after angioplasty. The high-dose group received a 1200-mg IV bolus and 1200 mg orally twice daily for 48 hours. All patients received IV isotonic saline, 0.9% at 1 mL/kg of body weight per hour (0.5 mL/kg per h for heart failure) for 12 hours. Outcomes: Contrast-medium–induced nephropathy (≥ 25% increase from baseline in serum creatinine level within 72 h after angioplasty). Secondary outcomes included in-hospital mortality and the composite endpoint of death, acute renal failure requiring renal-replacement therapy, or need for mechanical ventilation. Patient follow-up: 99.4%.