Author + information
- Received September 12, 2011
- Accepted September 15, 2011
- Published online January 1, 2012.
- Hitinder S. Gurm, MD⁎,⁎ (, )
- Dean E. Smith, PhD, MPH⁎,
- Otavio Berwanger, MD†,
- David Share, MD‡,
- Theodore Schreiber, MD§,
- Mauro Moscucci, MD, MBA∥,
- Brahmajee K. Nallamothu, MD, MPH⁎,
- BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium)
- ↵⁎Reprint requests and correspondence:
Dr. Hitinder S. Gurm, Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 2A394, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5853
Objectives The aim of this study was to examine the use of and outcomes associated with use of N-acetylcysteine (NAC) in real-world practice.
Background The role of NAC in the prevention of contrast-induced nephropathy (CIN) is controversial, leading to widely varying recommendations for its use.
Methods 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.
Results 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.
Conclusions 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.
The Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry is funded by Blue Cross Blue Shield of Michigan. The sponsor had no role in analysis, study design, or decision to publish these results. Dr. Gurm receives research funding from Blue Cross Blue Shield of Michigan and the National Institutes of Health. Dr. Share is employed part-time by Blue Cross Blue Shield of Michigan. Mauro Moscucci has received salary support from the Blue Cross Blue Shield of Michigan.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 12, 2011.
- Accepted September 15, 2011.
- American College of Cardiology Foundation