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

BackgroundAcute 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.MethodsWe 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.ResultsCIN 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.ConclusionsCombination 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.