Cargando…

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

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 re...

Descripción completa

Detalles Bibliográficos
Autores principales: Guo, Zhaodong, Liu, Jin, Lei, Li, Xue, Yan, Liu, Liwei, Huang, Hao, Chen, Shiqun, Liu, Yong, Lin, Yingzhong, Tao, Jianhong, Xu, Qingbo, Wu, Keng, Zhang, Lingyu, Chen, Ji-Yan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569944/
https://www.ncbi.nlm.nih.gov/pubmed/33067289
http://dx.doi.org/10.1136/bmjopen-2020-039009
_version_ 1783596836091592704
author Guo, Zhaodong
Liu, Jin
Lei, Li
Xue, Yan
Liu, Liwei
Huang, Hao
Chen, Shiqun
Liu, Yong
Lin, Yingzhong
Tao, Jianhong
Xu, Qingbo
Wu, Keng
Zhang, Lingyu
Chen, Ji-Yan
author_facet Guo, Zhaodong
Liu, Jin
Lei, Li
Xue, Yan
Liu, Liwei
Huang, Hao
Chen, Shiqun
Liu, Yong
Lin, Yingzhong
Tao, Jianhong
Xu, Qingbo
Wu, Keng
Zhang, Lingyu
Chen, Ji-Yan
author_sort Guo, Zhaodong
collection PubMed
description 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.
format Online
Article
Text
id pubmed-7569944
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-75699442020-10-21 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 Guo, Zhaodong Liu, Jin Lei, Li Xue, Yan Liu, Liwei Huang, Hao Chen, Shiqun Liu, Yong Lin, Yingzhong Tao, Jianhong Xu, Qingbo Wu, Keng Zhang, Lingyu Chen, Ji-Yan BMJ Open Cardiovascular Medicine 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. BMJ Publishing Group 2020-10-16 /pmc/articles/PMC7569944/ /pubmed/33067289 http://dx.doi.org/10.1136/bmjopen-2020-039009 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ 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/.
spellingShingle Cardiovascular Medicine
Guo, Zhaodong
Liu, Jin
Lei, Li
Xue, Yan
Liu, Liwei
Huang, Hao
Chen, Shiqun
Liu, Yong
Lin, Yingzhong
Tao, Jianhong
Xu, Qingbo
Wu, Keng
Zhang, Lingyu
Chen, Ji-Yan
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569944/
https://www.ncbi.nlm.nih.gov/pubmed/33067289
http://dx.doi.org/10.1136/bmjopen-2020-039009
work_keys_str_mv AT guozhaodong effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT liujin effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT leili effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT xueyan effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT liuliwei effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT huanghao effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT chenshiqun effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT liuyong effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT linyingzhong effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT taojianhong effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT xuqingbo effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT wukeng effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT zhanglingyu effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials
AT chenjiyan effectofnacetylcysteineonpreventionofcontrastassociatedacutekidneyinjuryinpatientswithstemiundergoingprimarypercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomisedcontrolledtrials