Contrast Nephropathy and Nitrates

The Contrast Nephropathy and Nitrates trial (CoNaN) is a single center, randomized, 1 x 1 factorial clinical trial designed to test the effects of intravenous nitroglycerin infusion in renal function given prior to PCI.

Specific aims for this trial include:

• To determine whether the intravenous nitrates have any effect on the glomerular filtration rate (GFR) after the exposure to contrast media.
• To determine if intravenous nitroglycerin will decrease the incidence of contrast induced Nephropathy.

400 patients with a Mehran score of > 6 and a pre-procedural creatinine measurement will be enrolled. Following baseline assessments, patients will be randomly assigned to receive intravenous infusion nitroglycerine plus intravenous normal saline or normal saline only. Subjects will participate in this study from the time they sign consent (prior to angiographic procedure), until 48-72 hours post procedure.

Inclusion criteria

• Patient must be scheduled for percutaneous coronary angiography.
• Patients must have a Mehran score more or equal to 6 before the procedure.
• Patients must have baseline creatinine and hemoblogin drawn before the procedure.
• Signed informed consent.

Exclusion criteria

• Patients on renal replacement therapy before randomization, will be excluded.
• Being exposed to any types of nitrates 48 hours prior to randomization,
• History of allergic reaction to any of the components of intravenous nitroglycerin.
• Exposure to contrast media 4 days prior randomization.
• Planned revascularization in the next 24 to 48 hours of the first PCI procedure.
• The patient is hypotensive (<90/60mmHg) at the time of randomization.