Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

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• 作者：Soo Hwan Park^a ; ^b ; Myung Ho Jeong^a ; ^b ; ^{myungho@chollian.net" class="auth_mail" title="E-mail the corresponding author} ; In Hyae Park^b ; Jin Soo Choi^b ; Jung Ae Rhee^b ; In Soo Kim^a ; Min Cheol Kim^a ; Jae Yeong Cho^a ; Doo Sun Sim^a ; Young Joon Hong^a ; Hyung Wook Park^a ; Ju Han Kim^a ; Youngkeun Ahn^a ; Jeong Gwan Cho^a ; Jong Chun Park^a ; Jung Chaee Kang^a
• 关键词：Nephropathy ; Statin ; N-acetylcysteine ; Myocardial infarction
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 June 2016
• 年：2016
• 卷：212
• 期：Complete
• 页码：100-106
• 全文大小：403 K

文摘

Acute myocardial infarction (AMI) is a risk factor for contrast-induced nephropathy (CIN). We investigated whether pretreatment with statin, N-acetylcysteine (NAC) and sodium bicarbonate (NaHCO₃) reduces the risk of CIN.

Methods

We conducted a prospective trial and enrolled a total of 334 ST-segment elevation myocardial infarction (STEMI) patients. Patients were divided into four groups: Group I (statin 40 mg), Group II (statin 80 mg), Group III (statin 80 mg plus NAC 1200 mg) and Group IV (regimen of group III plus NaHCO₃ 154 mEq/L). CIN was defined as ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine from the baseline within the 72 h after PCI.

Results

CIN occurred in 72 (21.6%) patients. The incidence of CIN was the lowest in the group III (14.3%), and multivariate analysis showed the lower incidence of CIN in group III compared to Group I [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.13–0.64, p = 0.002]. Admission hyperglycemia [(AHG) > 198 mg/dL] (OR 2.20, 95% Cl 1.20–3.68, p = 0.011) and the use of intra-aortic balloon pump (IABP) (OR 4.20, 95% CI 1.38–12.78, p = 0.016) were independent predictors for CIN. The CIN (OR 9.00, 95% CI 1.30–62.06, p = 0.026) was an independent predictor for in-hospital mortality.

Conclusions

Combination of high-dose statin plus NAC was associated with lower incidence of CIN in patients with STEMI who underwent primary PCI compared to statin only.