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-angiographyeGFR <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 angiographydefined by 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 hoursbetween the identification of the indication for angiography and the time of theplanned procedure.

• 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