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Comparison of N-acetylcysteine and ascorbic acid in prevention of renal dysfunction after coronary angioplasty  
DOI: 10.1102/1473-1827.2008.0001
 
Kamran Aghasadeghi and Vahid Akbari
 
   
 
     
  Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
Cardiology Department, Faghihi General Hospital, Shiraz, Iran
   
 
Corresponding address: Kamran Aghasadeghi MD, Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
E-mail: aghasadk@sums.ac.ir
 
Abstract
 

Background: Contrast agents can cause a reduction in renal function that may be due to generation of reactive oxygen species. Conflicting evidence suggests that administration of the antioxidant, N-acetylcysteine (NAC) prevents this renal impairment. The literature on the protective role of ascorbic acid is scarce.

Objectives: To compare the effects of NAC and ascorbic acid monotherapy with placebo in reducing the incidence of contrast-induced nephropathy (CIN) after coronary angioplasty.

Methods: We conducted a randomized, double-blind, placebo-controlled trial of NAC and ascorbic acid monotherapy in 150 patients with any baseline serum creatinine who underwent coronary angioplasty. NAC 600 mg b.i.d. for 2 days, ascorbic acid 1.5 g b.i.d. for 2 days or placebo administered orally with the first dose initiated on the day before the procedure. The primary end point of our study was the incidence of CIN, defined as a relative increase in serum creatinine of at least 25% measured 4 days after the procedure.

Result: CIN occurred in 4 of the 50 patients (8%) in the NAC group and in 5 of the 50 patients (10%) in the ascorbic acid group and in 16 of the 50 patients (32%) in the placebo group (x2=12.292, d.f.=2, P=0.002). Relative risk reduction against CIN in the NAC and ascorbic acid groups was 75% and 68.75%; the absolute risk reduction was 24% and 22%, respectively. The mean serum creatinine increased significantly in the placebo group (0.99 ± 0.21 to 1.15 ± 0.30, P=0.001) and non-significantly in the other groups (1.01 ± 0.20 to 1.15 ± 0.26 in the NAC group, 1.07 ± 0.31 to 1.12 ± 0.38 in the ascorbic acid group, P=0.9).

Conclusions: Ascorbic acid monotherapy is equally effective as NAC in preventing CIN in patients undergoing coronary angioplasty.

             
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