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

Background: Acutemyocardial 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.