No abstract

Percutaneous coronary intervention in chronic total occlusion is a rapidly evolving area, being considered the last frontier of interventional cardiology. In recent years, the development of new techniques and equipment, as well as the training of specialized personnel, increased their success rates, making it the most predictable procedure available. Although the number of randomized and controlled studies is still limited, results from large multicentered registries allow us to safely offer this intervention to patients, as another treatment option along with the optimized drug treatment and myocardial revascularization surgery. This review summarizes the last and most relevant publications in the subject in order to provide an overall view of the field’s current status.

Acetylcysteine is a safe, inexpensive, and readily available antioxidant that has been proposed as a prophylactic intervention for contrast-induced acute kidney injury on top of optimal hydration. In this regard, several randomized trials were completed and reached inconsistent results. 8,9 Such studies are limited by low statistical power and most failed to meet quality standards, such as allocation concealment, blinding, and intention-to-treat analysis. Systematic reviews have found high heterogeneity across studies, precluding definitive conclusions regarding the efficacy of acetylcysteine. [10][11][12][13][14][15] Despite the independent association between diabetes mellitus and contrast-induced acute kidney injury, to date, no large-scale trial has evaluated the effects of acetylcysteine in these patient population.The Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) 16 randomized 2308 patients undergoing anBackground-Diabetes mellitus represents an independent risk factor for contrast-induced acute kidney injury. We report the results of a prespecified substudy of patients with diabetes mellitus included in the Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT), the largest randomized study evaluating the effects of acetylcysteine for the prevention of contrast-induced acute kidney injury conducted to date. Methods and Results-From the 2308 patients included in the ACT, 1395 had diabetes mellitus and were considered for the present analysis. The study drugs (acetylcysteine 1200 mg or matching placebo) were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). Participants, healthcare staff, data collectors, and outcome assessors were blinded. All analysis followed the intention-totreat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 13.8% in the acetylcysteine group and 14.7% in the control group (relative risk 0.93; 95% confidence interval, 0.