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Circulation. 2011 Sep 13;124(11):1250-9. doi: 10.1161/CIRCULATIONAHA.111.038943. Epub 2011 Aug 22.

Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT).

Collaborators (200)

Berwanger O, Cavalcanti AB, Sousa AG, Buehler AM, Kodama AA, Carballo MT, Carvalho VO, Amodeo C, Lotaif LD, Sousa JE, Sousa AG, Carballo MT, Victor ES, Berwanger O, Cavalcanti AB, Sousa AG, Sousa JE, Amodeo C, Lotaif LD, Berwanger O, Cavalcanti AB, Buehler AM, Carballo MT, Kodama AA, Santucci E, Cardoso CE, Silva Dd, Mendes AL, Lobato J, Prates G, Yokoyama H, Almeida P, Pessoa C, Pessoa J, Martins H, Lopes M, Barros M, Reis H, Cordeiro C, Castello H, Cantarelli M, Ferreira S, Mattos C, Rati M, Medeiros C, Mangione JA, Mauro MF, Cristóvão SA, Carnieto NM, Rocha LC, Maksud DF, Barbosa C, Costantini C, Tarbine S, Santos M, Ortiz C, Souza A, Mattos C, Duarte L, Neto JM, Figueiredo G, Lemos D, Braga F, Novaes G, Oliveira F, Tonani M, Filho EV, Rocha E, Nunes P, Sá Filho A, Lima I, Muniz A, Loures J, Abraão A, Sousa J, Moreira A, Araújo E, Sousa L, Fonseca A, Soares J, Cunha C, Saad J, Câmara F, Falcheto E, Bergo R, Dall'Orto FT, Almeida R, Mendes R, Wainstein M, Ribeiro J, Teixeira C, Mattos C, Cunha F, Dall'Orto FT, Lisboa J, Osugui D, Stella F, Almeida J, Stella A, Assunção F, Souza S, Malachia J, Buononato P, Zappi D, Linhares M, Junckes M, Guimarães J, Filho DA, Maiello J, Seixas E, Almeida B, Janella B, Almeida M, Silva A, Marco A, Teixeira A, Pinto J, Thiago LS, Giuliano L, Aranha F, Arante D, Barbosa M, Filho FA, Gama C, Arêas C, Lacerda M, Freitas I, Dall'Orto FT, Oliveira LA, Oliveira IR, Pinheiro F, Amaral C, Gubolino L, Teixeirense P, Toledo JF, Sousa A, Feres F, Centemero M, Costa JR, Esteves V, Polacini J, Viana R, Thiago LS, Giuliano L, Antunes M, Conceição R, Azmus A, Quadros A, Ramalho G, Santos R, Garzon P, Faria D, Queirantes C, Galeazzi P, Cavallini V, Carvalho R, Botelho R, Rosa C, Seabra M, Pereira A, Reis S, Pereira V, Cunha S, Vitor P, Motta P, Osterne E, Souza FX, Motta V, Heleno MS, Ramalho KM, Cramer H, Júnior BS, Tura B, Cook D, Justen D, Paiva M, Czochra E, Potengi KC, Pinheiro F, Teixeirense P, Toledo JF, Gubolino L, Labrunie A, Andrade P, Tebet M, Muniz A, Loures J, Abraão A, Vankeulen MS, Pedroso NJ, Nunes G, Oliveira A, Roehrig C, Colnaghi I, Stella F, Candeias M, Scatamburlo L, Kloth V, Abreu S, Lima J.



It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury.


We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P=0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P=0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment.


In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography.

CLINICAL TRIAL REGISTRATION: Unique identifier: NCT00736866.

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