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Role of N-acetylcysteine in prevention of contrast-induced nephropathy after cardiac procedures FREE TO VIEW

Ramesh M. Gowda, MD; Michael Shapiro, DO; Ijaz A. Khan, MD; Keith Leibowitz, DO*; Deepika Misra, MD
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Beth Israel Medical Center, New York, NY


Chest. 2004;126(4_MeetingAbstracts):710S. doi:10.1378/chest.126.4_MeetingAbstracts.710S-a
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PURPOSE:  To study the usefulness of N-acetylcysteine in prevention of contrast-induced nephropathy after the intra-arterial administration of contrast for cardiac procedures.

METHODS:  We performed a meta-analysis of five prospective, randomized controlled trials on the role of periprocedure administration of N-acetylcysteine for the prevention of contrast-induced nephropathy after cardiac procedures. All of these trials included patients with impaired renal function, used low-osmolality non-ionic contrast media intra-arterially, administered a total of four doses of N-acetylcysteine, and had contrast-induced nephropathy as their primary outcome. The contrast-induced nephropathy was defined as an increase in serum creatinine concentration by >0.5mg/dl or 25% increase above baseline at or within 48 hours post procedure. Meta-analysis was performed using the Fisher Combined Test with a measure of effect size. The magnitude of the N-acetylcysteine effect was estimated using the random-effects model. Homogeneity was evaluated using the chi-square test of homogeneity and the standard Q statistic. To explore the presence of reporting bias Rosenthal’s method was used to calculate the number of negative studies that would have to exist in order to invalidate a significant overall p value.

RESULTS:  The Fisher Combined Test was significant at p<0.005 in favor of N-acetylcysteine. The size of the N-acetylcysteine effect was to reduce contrast-induced nephropathy by 20%. There was a 30% relative risk reduction of contrast-induced nephropathy in patients given N-acetylcysteine using the random-effects model. In addition, we found that 27 unpublished studies at a p=0.05 showing no effects of N-acetylcysteine would have to be tracked down to overturn the combined significance of p<0.005 of the five studies in our meta-analysis.

CONCLUSION:  The oral administration of N-acetylcysteine has a beneficial effect in prevention of contrast-induced nephropathy post cardiac procedures in patients with impaired renal function.

CLINICAL IMPLICATIONS:  The increased morbidity and higher health care costs associated with contrast-induced nephropathy can be effectively reduced by using N-acetylcysteine, which has minimal cost and lacks significant side effects.

DISCLOSURE:  K. Leibowitz, None.

Monday, October 25, 2004

10:30 AM- 12:00 PM




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