Prevention of Serious Adverse Events Following Angiography

Inclusion Criteria:

• Planned elective or urgent coronary or non-coronary angiography with iodinatedcontrast media in which it is anticipated that there will be an interval of 3 hoursbetween the identification of the indication for angiography and the time of theplanned procedure.
• Pre-angiography eGFR <60 ml/min/1.73 m2 with diabetes mellitus or pre-angiography eGFR <45 ml/min/1.73 m2 with or without diabetes mellitus
• Ability to provide informed consent

Exclusion Criteria:

• Stage 5 chronic kidney disease (CKD) (eGFR <15 mL/min/1.73 m2)
• Currently receiving hemodialysis, peritoneal dialysis, continuous renal replacementtherapy, or sustained low efficiency dialysis (SLED)
• Unstable baseline serum creatinine (SCr) (if known) at the time of angiography definedby an increase in SCr of 25% over the 3 days prior to angiography
• Decompensated heart failure requiring any of the following therapies at the time ofangiography:
• IV milrinone, amrinone, dobutamine, or nesiritide
• Isolated ultrafiltration therapy
• Intra-aortic balloon pump
• Emergent angiography procedures defined as an anticipated duration of <3 hours betweenthe identification of the indication for angiography and the time of the plannedprocedure.
• Receipt of intravascular iodinated contrast within the 5 days preceding angiography
• Receipt of oral or IV NAC within the 48 hours preceding angiography
• Known allergy to N-acetylcysteine (NAC)
• Known anaphylactic allergy to iodinated contrast media
• Prisoner
• Age <18 years
• Pregnancy
• Ongoing participation in an unapproved concurrent interventional study