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 res...
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/10/e039009.full |
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| author | LingYu Zhang Yong Liu Jin Liu Shiqun Chen Hao Huang Li Lei Liwei Liu Zhaodong Guo Ji-yan Chen Yan Xue Qingbo Xu Yingzhong Lin Jianhong Tao Keng Wu |
| author_facet | LingYu Zhang Yong Liu Jin Liu Shiqun Chen Hao Huang Li Lei Liwei Liu Zhaodong Guo Ji-yan Chen Yan Xue Qingbo Xu Yingzhong Lin Jianhong Tao Keng Wu |
| author_sort | LingYu Zhang |
| collection | DOAJ |
| 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 | Article |
| id | doaj-art-cf6689037fc8405080380dadc19c447a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-cf6689037fc8405080380dadc19c447a2024-11-16T03:05:07ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2020-039009Effect 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 trialsLingYu Zhang0Yong Liu1Jin Liu2Shiqun Chen3Hao Huang4Li Lei5Liwei Liu6Zhaodong Guo7Ji-yan Chen8Yan Xue9Qingbo Xu10Yingzhong Lin11Jianhong Tao12Keng Wu13Cardiology, Maoming People’s Hospital, Maoming, China2 Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People`s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China5 Institute of Clinical Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People`s Republic of ChinaCardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, ChinaDepartment of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USADepartment of Cardiology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, ChinaCardiology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China1 Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People`s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, ChinaDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China1 Department of Anesthesiology, Zhejiang Hospital, Hangzhou 310013, China5 Department of Cardiology, Maoming People’s Hospital, Maoming, ChinaDepartment of Cardiology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaCardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China5 Cardiology, The Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, ChinaObjective 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.https://bmjopen.bmj.com/content/10/10/e039009.full |
| spellingShingle | LingYu Zhang Yong Liu Jin Liu Shiqun Chen Hao Huang Li Lei Liwei Liu Zhaodong Guo Ji-yan Chen Yan Xue Qingbo Xu Yingzhong Lin Jianhong Tao Keng Wu 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 BMJ Open |
| 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 |
| url | https://bmjopen.bmj.com/content/10/10/e039009.full |
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