Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5853, USA.
JACC Cardiovasc Interv. 2012 Jan;5(1):98-104. doi: 10.1016/j.jcin.2011.09.019.
The aim of this study was to examine the use of and outcomes associated with use of N-acetylcysteine (NAC) in real-world practice.
The role of NAC in the prevention of contrast-induced nephropathy (CIN) is controversial, leading to widely varying recommendations for its use.
Use of NAC was assessed in consecutive patients undergoing nonemergent percutaneous coronary intervention from 2006 to 2009 in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, a large multicenter quality improvement collaborative. We examined the overall prevalence of NAC use in these patients and then used propensity matching to link its use with clinical outcomes, including CIN, nephropathy-requiring dialysis, and death.
Of the 90,578 percutaneous coronary interventions performed during the study period, NAC was used in 10,574 (11.6%) procedures, with its use steadily increasing over the study period. Patients treated with NAC were slightly older and more likely to have baseline renal insufficiency and other comorbidities. In propensity-matched, risk-adjusted models, we found no differences in outcomes between patients treated with NAC and those not receiving NAC for CIN (5.5% vs. 5.5%, p = 0.99), nephropathy-requiring dialysis (0.6% vs. 0.6%, p = 0.69), or death (0.6% vs. 0.8%, p = 0.15). These findings were consistent across many prespecified subgroups.
Use of NAC is common and has steadily increased over the study period but does not seem to be associated with improved clinical outcomes in real-world practice.
本研究旨在考察在真实实践中使用 N-乙酰半胱氨酸（NAC）的情况及其相关结果。
NAC 在预防对比剂诱导的肾病（CIN）中的作用存在争议，导致其使用建议差异很大。
在 2006 年至 2009 年期间，在密歇根蓝十字蓝盾心血管联盟（一个大型多中心质量改进合作组织）进行的非紧急经皮冠状动脉介入治疗的连续患者中评估了 NAC 的使用情况。我们检查了这些患者中 NAC 使用的总体流行率，然后使用倾向评分匹配将其使用与临床结果（包括 CIN、需要透析的肾病和死亡）联系起来。
在研究期间进行的 90578 例经皮冠状动脉介入治疗中，NAC 用于 10574 例（11.6%）手术，其使用在研究期间稳步增加。接受 NAC 治疗的患者年龄稍大，且更有可能存在基线肾功能不全和其他合并症。在倾向评分匹配、风险调整模型中，我们发现接受 NAC 治疗和未接受 NAC 治疗的患者在 CIN（5.5%对 5.5%，p=0.99）、需要透析的肾病（0.6%对 0.6%，p=0.69）或死亡（0.6%对 0.8%，p=0.15）方面的结局没有差异。这些发现在许多预先指定的亚组中是一致的。
NAC 的使用很常见，并且在研究期间稳步增加，但在真实实践中似乎并未改善临床结局。
