You are here

  • Home
  • Archive
  • Volume 10, Issue 10
  • Effect of N-acetylcysteine on prevention of contrast-associated acute kidney injury in patients with STEMI undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomised controlled trials

Article Text

Article menu
XML
Cardiovascular medicine
Original research
Effect of N-acetylcysteine on prevention of contrast-associated acute kidney injury in patients with STEMI undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomised controlled trials
  1. Zhaodong Guo1,
  2. Jin Liu1,
  3. Li Lei2,
  4. Yan Xue3,
  5. Liwei Liu2,
  6. Hao Huang4,
  7. Shiqun Chen1,
  8. Yong Liu1,2,5,
  9. Yingzhong Lin3,
  10. Jianhong Tao4,
  11. Qingbo Xu6,
  12. Keng Wu7,
  13. Lingyu Zhang6,
  14. Ji-Yan Chen1,2,5
  1. 1Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  2. 2Cardiology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
  3. 3Department of Cardiology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
  4. 4Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
  5. 5Cardiology, Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
  6. 6Cardiology, Maoming People’s Hospital, Maoming, China
  7. 7Cardiology, The Affiliated Hospital, Guangdong Medical University, Zhanjiang, China
  1. Correspondence to Dr Yong Liu; lyys2099{at}126.com

Abstract

Objective Several studies evaluating the preventive effect of N-acetylcysteine (NAC) on contrast-associated acute kidney injury (CA-AKI) among patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) have suggested inconsistent results and that a systematic review and meta-analysis should be performed.

Design Systematic review and meta-analysis.

Data sources PubMed, MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Central databases were searched from inception to 15 November 2019.

Eligibility criteria Randomised controlled trials assessing use of NAC compared with non-use of NAC (eg, placebo) in preventing CA-AKI in patients with STEMI following PPCI were included.

Data synthesis Relative risks with 95% CIs were pooled using a random-effects model. Evidence level of conclusions was assessed by Cochrane GRADE measure.

Results Seven trials including 1710 patients were identified. Compared with non-use of NAC, use of NAC significantly reduced the incidence of CA-AKI by 49% (risk ratio (RR) 0.51, 95% CI 0.31 to 0.82, p<0.01) and all-cause in-hospital mortality by 63% (RR 0.37, 95% CI 0.17 to 0.79, p=0.01). The estimated effects on the requirement for dialysis (RR 0.61, 95% CI 0.11 to 3.38, p=0.24) were not statistically significant. Trial sequential analysis confirmed the true positive of NAC in reducing risk of CA-AKI. Subgroup analyses suggested that the administration of NAC had greater benefits in patients with renal dysfunction and in those receiving oral administration and higher dosage of NAC.

Conclusions NAC intake reduces the risk of CA-AKI and all-cause in-hospital mortality in patients with STEMI undergoing PPCI. The estimated potential benefit of NAC in preventing dialysis was ambiguous, and further high-quality studies are needed.

PROSPERO registration number CRD42020155265.

  • cardiology
  • coronary intervention
  • myocardial infarction
  • acute renal failure
  • coronary heart disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-039009

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Supplementary materials

    Footnotes

    • Contributors ZG had full access to all of the data in the manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: ZG and YoL. Acquisition, analysis or interpretation of data: ZG, JL, LLi, YX, HH, SC, YoL, JT, QX, KW, LZ and J-YC. Drafting of the manuscript: ZG and YL. Critical revision of the manuscript for important intellectual content: ZG, YiL, JL, LLe and YX. Statistical analysis: ZG. Supervision: YiL and JL.

    • Funding The study received funding from the Science and Technology Planning Project of Guangdong Province (PRECOMIN study, no 2008A030201002), Beijing Lisheng Cardiovascular Pilot Foundation (grant no LHJJ201612127), ‘Lixin Yangfan’ Optimized Anti-thrombus Research Fund (grant no BJUHFCSOARF201801-10), the Progress in Science and Technology Project of Guangzhou (grant no 201904010470), the Access Research Fund (grant no 2018-CCA-AF-037), the China Youth Clinical Research Fund (grant no 2017-CCA-VG-020), the High-level Hospital Construction Project (DFJH201919), the National Science Foundation of China (grant no 81670339 and 81970311), and the Guangdong Scientific Research Foundation (A2019414).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.