6/28/23, 12:00 AM ACT Pathway Feedback Search Clinical Topics Home Studies ACT ACT Disease Disease Disease Acute kidney injury Contrast-induced nephropathy Coronary Trial question What is the role of acetylcysteine for the prevention of contrast-induced AKI in patients undergoing coronary and peripheral vascular angiography? Study design Multi-center Double blinded RCT Population Characteristics of study participants 39.0% female N = 2308 61.0% male 2308 patients (892 female, 1416 male) Inclusion criteria: patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced AKI (age > 70 years, renal failure, diabetes mellitus, HF, or hypotension) Key exclusion criteria: patients on dialysis, ST-segment elevation myocardial infarction undergoing primary angioplasty, pregnant, breastfeeding, or women aged < 45 years and did not use contraceptive methods Interventions N=1172 acetylcysteine (1200 mg BID PO, for 2 doses before and 2 doses after the procedure) N=1136 placebo (matching placebo BID PO, for 2 doses before and 2 doses after the procedure) https://web.pathway.md/studies/recIpIDHfUTkZaVWh 1/2 6/28/23, 12:00 AM ACT Pathway Primary outcome Contrast-induced acute kidney injury 12.7 % 12.7 12.7 9.5 % 6.3 % 3.2 % No significant difference 0.0 % Acetylcysteine Placebo No significant difference in contrast-induced AKI (12.7% vs. 12.7%; RR 1, 95% CI 0.81 to 1.25) Secondary outcomes No significant difference in death or need for dialysis at 30 days (2.2% vs. 2.3%; HR 0.97, 95% CI 0.56 to 1.69) No significant difference in death, need for dialysis, or doubling in serum creatinine at 30 days (3.2% vs. 3.6%; RR 0.9, 95% CI 0.58 to 1.39) No significant difference in death at 30 days (2% vs. 2.1%; HR 0.97, 95% CI 0.54 to 1.73) Safety outcomes No significant differences in any other adverse events, except for vomiting (0.3% vs. 1.2%, p=0.02). Significant differences in other serious adverse events (1.3% vs. 2.2%, p = 0.09). Conclusion In patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced AKI (age > 70 years, renal failure, diabetes mellitus, HF, or hypotension), acetylcysteine was not superior to placebo with respect to a contrast-induced AKI. Reference ACT Investigators. 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). Circulation. 2011 Sep 13;124(11):1250-9. Open reference URL https://web.pathway.md/studies/recIpIDHfUTkZaVWh 2/2