Contrast Agent Additive Offers Cardiorenal Protection

Novel use of N-acetylcysteine with contrast agent iopamidol successful in test on pigs

WEDNESDAY, March 18 (HealthDay News) -- Adding N-acetylcysteine (NAC) to a contrast agent offered protection from contrast-induced nephropathy and protected at-risk myocardium in a study in which ischemia and reperfusion were induced in pigs, according to research reported in the March issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Markus Meyer, M.D., of the University of Vermont College of Medicine in Burlington, and colleagues added 12 mL of NAC to 200 mL of the contrast agent iopamidol and injected it into seven pigs, while five pigs received iopamidol only. In each, the researchers used a guidewire and balloon to occlude the left anterior descending artery for 60 minutes. After 24 hours, heart function was assessed, and the hearts were harvested for examination. Terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was used to evaluate myocardium; creatinine level was used to evaluate renal function.

In myocardium from non-infarcted at-risk areas, a mean 32.1 percent of nuclei stained TUNEL positive in the controls, compared with a mean 1.6 percent in the pigs receiving NAC, demonstrating a NAC protective effect, the researchers report. Mean creatinine levels were 1.49 mg/dL in the NAC group compared with 1.82 mg/dL in the control group, demonstrating a NAC protective effect in renal tissue. The investigators found an increase in arrhythmias during ischemia and reperfusion in the NAC group.

"We have demonstrated the feasibility and efficacy of delivering NAC in conjunction with an intracoronary contrast agent to provide combined cardiac and renal protection in the setting of ischemia-reperfusion. This observation may have potential application in clinic practice," the authors conclude.

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