N-acetylcysteine: short-term clinical benefits after coronary angiography in high-risk renal patients.

INTRODUCTION AND OBJECTIVES: Previous studies on the role of N-acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography and on the drug's long-term effects have produced contradictory findings. The aim of this study was to clarify the benefits of N-acetylcysteine. METHODS: A prospective, randomized, double-blind study was carried out in patients with chronic renal failure (plasma creatinine= >or=1.4 mg/dL) who underwent coronary angiography. This study concerns the second arm of the main study. Findings on the arm involving patients with normal renal function have been published previously. As before, patients were randomly assigned to receive either N-acetylcysteine, 600 mg every 12 h intravenously, or placebo. The primary end-point was the development of contrast-induced nephropathy. RESULTS: The study included 81 patients (39 on N-acetylcysteine, 42 on placebo) with comparable baseline clinical characteristics. The overall incidence of contrast-induced nephropathy was 14.8% (12 patients): 5.1% (2 patients) in the N-acetylcysteine group and 23.8% (10 patients) in the placebo group (odds ratio [OR]=0.17; 95% confidence interval [CI], 0.03-0.84; P=.027). One patient (1.2%) in the latter group required dialysis while in the coronary unit. Multivariate analysis showed that N-acetylcysteine was an independent protective factor against the composite end-point of contrast-induced nephropathy, need for dialysis and mortality during the coronary unit stay (OR=0.20; 95% CI, 0.04-0.97; P=.04). Nevertheless, no significant difference was observed between the N-acetylcysteine and placebo groups in the rates of in-hospital (10.3% vs. 16.7%, respectively) or 1-year mortality (15.4% vs. 21.4%, respectively). CONCLUSIONS: Prophylactic administration of N-acetylcysteine provided significant short-term clinical benefits in high-risk renal patients who underwent coronary angiography.

N-acetilcisteína: beneficio clínico a corto plazo tras coronariografía en pacientes renales de alto riesgo / N-acetylcysteine: short-term clinical benefits after coronary angiography in high-risk renal patients

Introducción y objetivos. El papel de la N-acetilcisteína en la prevención de la nefropatía por contraste tras coronariografía y sus efectos a largo plazo se presentan con resultados contradictorios en la literatura previa. Este estudio pretende clarificar su beneficio clínico. Métodos. Estudio prospectivo, aleatorizado y a doble ciego de pacientes sometidos a angiografía coronaria con insuficiencia renal crónica (creatinina plasmática ≥ 1,4 mg/dl). Representa así el segundo brazo del diseño del estudio principal, previamente publicado, respecto al brazo de pacientes con función renal normal. Igualmente, se los aleatorizó a recibir N-acetilcisteína intravenosa (600 mg/12 h) o placebo. El objetivo principal es el desarrollo de nefropatía inducida por contraste. Resultados. Se incluyó a 81 pacientes (N-acetilcisteína, 39 pacientes; placebo, 42 pacientes), equiparables respecto a las características clínicas basales. La incidencia total de nefropatía por contraste fue del 14,8% (12 pacientes), el 5,1% (2 pacientes) en el grupo con N-acetilcisteína y el 23,8% (10 pacientes) en el grupo a placebo (odds ratio [OR] = 0,17; intervalo de confianza [IC] del 95%, 0,03-0,84); p = 0,027). Un paciente de este último grupo requirió diálisis mientras se encontraba ingresado en la unidad coronaria (1,2%). En el análisis multivariable, la N-acetilcisteína resultó factor protector independiente de la variable compuesta por nefropatía inducida por contraste, necesidad de diálisis y mortalidad durante la estancia en la unidad coronaria (OR = 0,20; IC del 95%, 0,04-0,97; p = 0,04). Sin embargo, no se observaron diferencias significativas en cuanto a mortalidad hospitalaria y al año de seguimiento (el 10,3 frente al 16,7% y el 15,4 frente al 21,4% en los grupos con N-acetilcisteína y placebo respectivamente). Conclusiones. La administración profiláctica de N-acetilcisteína conlleva importantes beneficios clínicos a corto plazo en los pacientes renales con alto riesgo sometidos a angiografía coronaria (AU)

Introduction and objectives. Previous studies on the role of N-acetylcysteine in the prevention of contrastinduced nephropathy after coronary angiography and on the drug’s long-term effects have produced contradictory findings. The aim of this study was to clarify the benefits of N-acetylcysteine. Methods. A prospective, randomized, double-blind study was carried out in patients with chronic renal failure (plasma creatinine=1.4 mg/dL) who underwent coronary angiography. This study concerns the second arm of the main study. Findings on the arm involving patients with normal renal function have been published previously. As before, patients were randomly assigned to receive either N-acetylcysteine, 600 mg every 12 h intravenously, or placebo. The primary end-point was the development of contrast-induced nephropathy. Results. The study included 81 patients (39 on N-acetylcysteine, 42 on placebo) with comparable baseline clinical characteristics. The overall incidence of contrast-induced nephropathy was 14.8% (12 patients): 5.1% (2 patients) in the N-acetylcysteine group and 23.8% (10 patients) in the placebo group (odds ratio [OR]=0.17; 95% confidence interval [CI], 0.03-0.84; P=.027). One patient (1.2%) in the latter group required dialysis while in the coronary unit. Multivariate analysis showed that N-acetylcysteine was an independent protective factor against the composite end-point of contrast-induced nephropathy, need for dialysis and mortality during the coronary unit stay (OR=0.20; 95% CI, 0.04-0.97; P=.04). Nevertheless, no significant difference was observed between the N-acetylcysteine and placebo groups in the rates of in-hospital (10.3% vs. 16.7%, respectively) or 1-year mortality (15.4% vs. 21.4%, respectively). Conclusions. Prophylactic administration of N-acetylcysteine provided significant short-term clinical benefits in high-risk renal patients who underwent coronary angiography (AU)

Preoperative use of sotalol versus atenolol for atrial fibrillation after cardiac surgery.

BACKGROUND: Atrial fibrillation is one of the most common complications of cardiac surgery. Beta blockers have been demonstrated to decrease the incidence of postoperative atrial fibrillation. Preliminary investigations reporting sotalol and atenolol to be effective in preventing postoperative atrial fibrillation are encouraging, but no studies have been conducted comparing both drugs. METHODS: A total of 253 consecutive eligible patients (66 +/- 8 years; mean +/- standard deviation) scheduled to undergo cardiac surgery were enrolled in this study. Patients were randomized in a prospective open manner 1.5:1 to atenolol group (50 mg/daily; 153 patients) or sotalol group (80 mg twice daily; 100 patients). RESULTS: Atrial fibrillation occurred in 44/253 patients (17.45%). A significant difference was found in the occurrence of atrial fibrillation in the atenolol group (34 patients, 22%) compared with those receiving sotalol (10 patients, 10%; p = 0.013). Therapeutic efficiency and efficacy was 12% and 54%, respectively. Stepwise logistic regression analysis revealed that age more than 68 years old (odds ratio = 2.72; 95% confidence interval [CI] = 1.37-5.41; p = 0.004), the use of beta-adrenergic agents (odds ratio = 2.74; 95% CI = 1.5-5; p = 0.001), and sotalol (odds ratio = 0.46; 95% CI = 0.23-0.95; p = 0.035) were independently associated with development of atrial fibrillation. CONCLUSIONS: Oral low-dose sotalol provides a considerable reduction in the occurrence of atrial fibrillation. A selective approach based on clinical risk prediction should decrease the occurrence of atrial fibrillation after cardiac surgery.