Acetylcysteine for prevention renal outcomes in patients undergoing coronary and peripheral vascular angiography

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