ACT Trial: Acetylcysteine for Contrast-Induced Nephropathy Trial

The ACT trial was published in 2011 and was one of the largest trial that assessed the use of acetylcysteine for the prevention of contrast-induced nephropathy in patients who were undergoing coronary or peripheral angiograms. The trial recruited 2308 patients who were undergoing an intravascular angiographic procedure and had risk factors for developing acute kidney injury such as age of more than 70, renal failure, diabetes, heart failure or hypotension for any reason. The patients were randomized to twice daily dosing of orally administered acetylcysteine 1200 mg or placebo. The drugs were administered twice daily for 2 doses before and after the procedure. The trial showed no benefits of using acetylcysteine over placebo as the incidence of contrast-induced AKI was similar in both groups (12.7%, respectively; P=0.97). Mortality or need of dialysis was also noted to be similar in both groups, P=0.92.  

Acetylcysteine has been coined to be a game-changer for contrast-induced AKI however almost all the trials that tested it either against placebo or against normal saline failed to show its efficacy. Therefore, it's not recommended anymore. The ACT trial authors concluded that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography. 

Check out the visual abstract summary of the ACT trial. Feel free to share it with others. Also, check out the PRESERVE trial that tested outcomes after angiography with sodium bicarbonate vs acetylcysteine.