Table 1.
Study Characteristics*
| Total Patients | Treatment Group, N | Control Group, N | Jadad23 Score | |||||
|---|---|---|---|---|---|---|---|---|
| Trial (Year) | Treatment Protocol | Control Protocol | Enrollment Criteria | Blinding | ||||
| Saidin28 (2006) | 57 | 29 | Oral N-acetylcysteine plus sodium bicarbonate. Oral N-acetylcysteine plus sodium bicarbonate 2 hours before and 6 hours after procedure. | 28 | Oral N-acetylcysteine plus normal saline. Oral N-acetylcysteine plus normal saline 2 hours before and 6 hours after procedure. | Coronary angiography or angioplasty, CKD stages 2–4. | Double-Blind | 2 |
| Brigouri14 (2007) | 351 | 10 8 | Oral N-acetylcysteine plus sodium bicarbonate. Isotonic saline (0.9%) IV at 1 mL/kg/hr (0.5mL/kg/hr for EF<40) for 12 hours before and 12 hours after contrast exposure. Oral 1,200mg N-acetylcysteine twice a day for day before and after procedure with 154 mEq/L sodium bicarbonate in dextrose and H2O (Merten Protocol29): initial IV bolus 3mL/kg/h for 1 hour immediately prior to contrast; during and for 6 hours after contrast exposure with same dose at 1mL/kg/hr. | 111 | Oral N-acetylcysteine plus IV hydration. Isotonic saline (0.9%) IV at 1 mL/kg/hr (0.5mL/kg/hr for EF<40) for 12 hours before and 12 hours after contrast exposure. Oral 1,200mg N-acetylcysteine twice a day for day before and after procedure. | Coronary and/or peripheral angiography and/or angioplasty with chronic kidney disease, Creatinine ≥2mg/dL or eGFR<40 mL min−1 1.73m−2, age ≥18. | Double-Blind | 3 |
| 107 | Oral N-acetylcysteine plus IV hydration plus IV ascorbic acid. Isotonic saline (0.9%) IV at 1 mL/kg/hr (0.5mL/kg/hr for EF<40) for 12 hours before and 12 hours after contrast exposure. Oral 1,200mg N-acetylcysteine twice a day for day before and after procedure with 3g IV ascorbic acid 2 hours before contrast and 2g the night and morning after contrast. | Double-Blind | 3 | |||||
| Heguillen23 (2007) | 27 | 9 | Oral N-acetylcysteine plus sodium bicarbonate. Oral 600mg N-acetylcysteine twice a day for day before and of procedure with 154 mEq/L sodium bicarbonate at 3mL/kg/h for 1 hour immediately prior to procedure; and at 1mL/kg/h for 6 hours after procedure. | 9 | Oral N-acetylcysteine plus normal saline. Oral 600mg N- acetylcysteine twice a day for day before and of procedure with 154 mEq/L normal saline at 3mL/kg/h for 1 hour immediately prior to procedure; and at 1mL/kg/h for 6 hours after procedure. | Coronary angiography or angioplasty, serum creatinine >1.25 (mg/dL), eGFR<50 mL min-1 1.73m-2, age ≥18. | Single-Blind | 2 |
| Kim24 (2007) | 100 | 31 | Oral N-acetylcysteine plus sodium bicarbonate. Oral 600mg N-acetylcysteine twice a day for two days with 80 mEq/L sodium bicarbonate at 1mL/kg/h for 12 hour prior to procedure and for 12 hours after procedure. | 20 | Oral N-acetylcysteine plus normal saline. Oral 600mg N- acetylcysteine twice a day for two days with 80 mEq/L normal saline at 1mL/kg/h for 12 hour prior to procedure and for 12 hours after procedure. | Elective coronary angiography, serum creatinine >1.5 (mg/dL), proteinurea>5 00 mg/day. | Single-Blind | 1 |
| Lin25 (2007) | 45 | 21 | Oral N-acetylcysteine plus sodium bicarbonate. Oral 600mg N-acetylcysteine twice a day for day of and day after procedure with 154 mEq/L sodium bicarbonate at 3mL/kg/h for 1 hour prior to procedure and for 6 hours after procedure. | 24 | Oral N-acetylcysteine plus normal saline. Oral 600mg N- acetylcysteine twice a day for day of and day after procedure with 154 mEq/L normal saline at 3mL/kg/h for 1 hour prior to procedure and for 6 hours after procedure. | Coronary angiography, angioplasty, serum creatinine <2.0 (mg/dL). | Single-Blind | 1 |
| Recio- Mayoral15 (2007) | 111 | 56 | IV N-acetylcysteine plus sodium bicarbonate. Initial IV bolus 5mL/kg/hr alkaline saline with 154 mEq/L sodium bicarbonate in 5% glucose and H2O plus 2,400mg N- acetylcysteine in same solution over 1 hour. Following contrast, same fluids continued without N- acetylcysteine at 1.5 mL/kg/hr for 12 hours plus 2 oral doses of 600mg N-acetylcysteine the day after contrast. | 55 | Oral N-acetylcysteine plus hydration. Isotonic saine (0.9%) at 1mL/kg/hr for 12 hours after contrast plus 2 oral doses of 600mg N-acetylcysteine the day after contrast. | Patients with MI undergoing primary or rescue PCI or high-risk non- STEMI requiring urgent PCI. | Single-Blind | 2 |
| Shaikh29 (2007) | 320 | 80 | IV N-acetylcysteine plus sodium bicarbonate. IV N-acetylcysteine with 154 mEq/L sodium bicarbonate at 3mL/kg/h for 1 hour prior to procedure and 1mL/kg/h for 6 hours after procedure. | 81 | IV N-acetylcysteine plus normal saline. IV N-acetylcysteine with 154 mEq/L normal saline at 3mL/kg/h for 1 hour prior to procedure and 1mL/kg/h for 6 hours after procedure. | High risk catheterization. | Single-Blind | 1 |
| Brar22 (2008) | 353 | 73 | Oral N-acetylcysteine plus sodium bicarbonate. Oral 600mg N-acetylcysteine twice a day for day before and day of the procedure with sodium bicarbonate at 3mL/kg/h for 1 hour prior to procedure and 1.5mL/kg/h during and for 6 hours after procedure. | 78 | Oral N-acetylcysteine plus normal saline. Oral 600mg N- acetylcysteine twice a day for day before and day of the procedure with normal saline at 3mL/kg/h for 1 hour prior to procedure and 1.5mL/kg/h during and for 6 hours after procedure. | Coronary angiography eGFR<60 mL min−1 1.73m−2, age ≥18, 1 + of either diabetes, congestive heart failure, hypertension, or age>75 years. | Single-Blind | 3 |
| Maioli26 (2008) | 502 | 25 0 | Oral N-acetylcysteine plus sodium bicarbonate. Oral 600mg N-acetylcysteine twice a day for day before and after procedure with 154 mEq/L sodium bicarbonate in dextrose and H2O (Merten Protocol29): initial IV bolus 3mL/kg/h for 1 hour immediately prior to contrast; during and for 6 hours after contrast exposure with same dose at 1mL/kg/hr. | 252 | Oral N-acetylcysteine plus normal saline. Isotonic saline (0.9%) IV at 1 mL/kg/hr for 12 hours before and 12 hours after contrast exposure. Oral 600mg N-acetylcysteine twice a day for day before and after procedure. | Coronary angiography eGFR<60 mL min−1 1.73m−2, age ≥18, 1 + of either diabetes, congestive heart failure, hypertension, or age>75 years. | Single-Blind | 3 |
| Ruiz27 (2008) | 128 | 32 | Oral N-acetylcysteine plus sodium bicarbonate. Methods not described. | 32 | Oral N-acetylcysteine plus normal saline. Methods not described. | Coronary and/or peripheral angiography, angioplasty, creatinine >1.5 (mg/dL) or diabetics creatinine >1.2 (mg/dL). | Single-Blind | 1 |
*
All studies investigating combination of N-acetylcysteine plus sodium bicarbonate were included. IV: intravenous; EF: ejection fraction (%); MI: myocardial infarction; STEMI: ST-elevation MI; PCI: percutaneous coronary intervention; eGFR: estimated glomerular filtration rate using MDRD equation.