NITRATE-CIN: Does Inorganic Nitrate Improve Safety of Coronary Angiography For Patients at Renal Injury Risk?

Inorganic nitrate reduced contrast-induced nephropathy (CIN) improved renal outcomes and reduced cardiac events compared to placebo in patients at risk of renal injury undergoing coronary angiography for acute coronary syndrome, according to results from the NITRATE-CIN trial presented at ESC Congress 2023.

Researchers randomized a total of 640 patients over a three-year period to receive 12 mmol of inorganic potassium nitrate (n=319) or placebo capsules (n=321) daily for five days. The mean age of trial participants was 71 years, approximately 73% were men, 75% were Caucasian, 46% had diabetes and 56% had chronic kidney disease. The median follow up was one year.

Overall findings showed that inorganic nitrate treatment significantly reduced CIN rates compared with placebo (9.1% vs. 30.5%, respectively). This difference persisted after adjustment for baseline creatinine concentration and diabetes status, according to study investigators. Additionally, secondary outcomes were improved with inorganic nitrate vs. placebo, with lower rates of procedural myocardial infarction (2.7% vs. 12.5%), improved three-month renal function, and reduced one-year MACE (9.1% vs. 18.1%).

"These findings could have important implications for health systems by reducing the burden of CIN and the associated prolonged admissions, dialysis and significant costs," said Dan Jones, MD, from Queen Mary University of London. "Further studies powered for adverse cardiac events are needed to confirm these findings."

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC Congress, ESC23, ACC International, Acute Coronary Syndrome, Acute Kidney Injury, Coronary Angiography

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