NITRATE-CIN
Trial question
What is the role of inorganic nitrate in patients at risk of renal injury undergoing coronary angiography for acute coronary syndromes?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
27.0% female
73.0% male
N = 640
640 patients (171 female, 469 male).
Inclusion criteria: patients at risk of renal injury undergoing coronary angiography for acute coronary syndromes.
Key exclusion criteria: cardiac arrest; cardiogenic shock; STEMI; chronic kidney failure; pregnancy.
Interventions
N=319 inorganic nitrate (potassium nitrate 12 mmol, equivalent to 744 mg of nitrate, once daily for 5 days, with the first dose taken before coronary angiography).
N=321 placebo (potassium chloride once daily for 5 days).
Primary outcome
Contrast-induced nephropathy
9.1%
30.5%
30.5 %
22.9 %
15.3 %
7.6 %
0.0 %
Inorganic
nitrate
Placebo
Significant
decrease ▼
NNT = 4
Significant decrease in contrast-induced nephropathy (9.1% vs. 30.5%; OR 0.21, 95% CI 0.13 to 0.34).
Secondary outcomes
Significant decrease in major adverse cardiac events at 1 year (9.1% vs. 18.1%; OR 0.45, 95% CI 0.28 to 0.73).
Significant decrease in all-cause mortality (5.4% vs. 10.9%; OR 0.46, 95% CI 0.25 to 0.84).
Significant decrease in major adverse kidney events at 1 year (10.7% vs. 28.4%; OR 0.3, 95% CI 0.19 to 0.46).
Conclusion
In patients at risk of renal injury undergoing coronary angiography for acute coronary syndromes, inorganic nitrate was superior to placebo with respect to a contrast-induced nephropathy.
Reference
Daniel A Jones, Anne-Marie Beirne, Matthew Kelham et al. Inorganic nitrate benefits contrast-induced nephropathy after coronary angiography for acute coronary syndromes: the NITRATE-CIN trial. Eur Heart J. 2024 May 13;45(18):1647-1658.
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