Probucol for the prevention of cystatin C-based contrast-induced acute kidney injury following primary or urgent angioplasty: A randomized, controlled trial

Background: Probucol, a lipid-lowering drug with potent antioxidant properties, may reduce the risk of cystatin C (CyC)-based contrast-induced acute kidney injury (CIAKI). The aim of this study was to observe the incidence of CyC-based CIAKI and assess the efficacy of probucol on prevention of CIAKI following primary or urgent coronary angioplasty. Methods: A total of 204 patients with acute coronary syndrome (ACS) were prospectively randomized to a control group (108 patients, 74 male, 65.4 +/- 12.5 years) or probucol group (96 patients, 67 male, 65.1 +/- 10.5 years) 1000 mg orally before primary or urgent angioplasty and 500 mg twice daily for 3 days following intervention. Serum CyC and serum creatinine (Scr) concentrations were measured before, and on day 1, day 2 and day 3 after coronary intervention. Results: The clinical characteristics of the patients from the two groups were similar. Scr-based CIAKI was developed in 23 patients of the control group (21.3%) and in 4 patients of the probucol group (4.2%) (P<0.001). Furthermore, CyC-based CIAKI occurred in 56 patients of the control group (51.9%) and 28 patients of the probucol group (29.2%) (P<0.001). The CyC increase >= 10% after exposure to contrast medium was the best increment cutoff value for the early identification of patients at risk of CIAKI. Conclusions: Our study suggests that CyC is a reliable marker for early identification and ruling out the patients at the risk of CIAKI. Among the patients with ACS who are undergoing primary or urgent angioplasty, prophylactic treatment with probucol reduces the risk of both Scr and CyC-based CIAKI. (C) 2012 Elsevier Ireland Ltd. All rights reserved.