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#362
17.11.2010, 18:19
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ACT: No benefit of N-acetylcysteine to reduce contrast-induced nephropathy
Chicago, IL - The addition of N-acetylcysteine failed to reduce the risk of contrast-induced nephropathy in patients undergoing coronary and vascular angiography. The findings, from the Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT), the largest randomized study to date, provide solid evidence that N-acetylcysteine is not effective in this setting and should no longer be used for the prevention of contrast-induced nephropathy, according to investigators. "I would be comfortable saying that this is a definitive trial, and I'd be comfortable saying that because if you look at the other high-quality trials, we reached exactly the same result," Dr Otavio Berwanger (Hospital do Coração, São Paulo, Brazil) told heartwire. "It would be extremely unlikely that another trial would be conducted, say a larger 20 000-patient trial, and would find a different result. One thing that is interesting with negative trials is that there is often a subgroup, maybe sicker patients, the elderly, that might have a different result. But here, it was very consistent." Presenting the results of the study today during the late-breaking clinical-trials session here at the American Heart Association (AHA) 2010 Scientific Sessions, Berwanger explained that N-acetylcysteine, an antioxidant, has been used as adjunctive therapy for about 10 years to reduce kidney injury caused by contrast used in coronary and vascular angiography. Despite its use, however, the evidence accumulated to date is conflicting, leaving questions about its role in clinical practice. In ACT, investigators randomized 2308 patients undergoing an angiographic procedure to 1200 mg of N-acetylcysteine, prescribed orally twice daily, with two doses given before the procedure and two doses after the procedure, or to placebo. Despite treatment with N-acetylcysteine, they observed "absolutely no difference" in the primary end point of contrast-induced nephropathy and no difference in the secondary end point of serum creatinine elevations. Similarly, 30-day clinical end points, including mortality, the need for dialysis, or cardiovascular mortality, were no different between placebo- and N-acetylcysteine-treated patients. A subgroup analysis revealed no benefit in any patient population, including patients stratified by age, the presence of diabetes mellitus, sex, serum creatinine levels, or type of contrast used prior to angiography. Berwanger and colleagues also performed their own meta-analysis, looking only at other high-quality studies, and observed no reduction in risk with N-acetylcysteine. Those results, Berwanger told heartwire, are in line with the lack of benefit observed in ACT. 
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#363
17.11.2010, 23:51
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Почему-то я считал, что для профилактики нефропатии АЦЦ нужно вводить парэнтерально - и именно поэтому он не так популярен в России.
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#364
20.11.2010, 16:18
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ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography
[Ссылки доступны только зарегистрированным пользователям ]
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#365
29.11.2010, 22:24
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Диагностика и лечение фибрилляции предсердий 2010
Рекомендации рабочей группы по нарушениям сердечного ритма Ассоциации кардиологов Украины Фактически это перевод ESC 2010 Guidelines for the management of atrial fibrillation [Ссылки доступны только зарегистрированным пользователям ]
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#366
01.12.2010, 14:35
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ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 Performance Measures for Adults With Peripheral Artery Disease
[Ссылки доступны только зарегистрированным пользователям ]
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#367
03.12.2010, 20:42
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Focused Cardiac Ultrasound in the Emergent Setting:
A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians [Ссылки доступны только зарегистрированным пользователям ]
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#368
03.12.2010, 21:30
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Небольшая подборка по визуализации сонных артерий при инсульте [Ссылки доступны только зарегистрированным пользователям ], может кому пригодится.
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#369
04.12.2010, 13:34
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Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Stroke published online Dec 2, 2010; [Ссылки доступны только зарегистрированным пользователям ]
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#371
18.12.2010, 14:22
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Цитата:
[Ссылки доступны только зарегистрированным пользователям ]
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#372
18.12.2010, 15:26
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Цитата:
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#373
18.12.2010, 21:54
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Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Review of NICE technology appraisal guidance 90 [Ссылки доступны только зарегистрированным пользователям ]
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#374
21.12.2010, 21:52
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Не боян?
ACCF/AHA/HRS FOCUSED UPDATE 2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline) [Ссылки доступны только зарегистрированным пользователям ]
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Линейный вид
