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Purpose <p>Contrast-associated acute kidney injury (CA-AKI) is a significant concern following percutaneous coronary intervention (PCI). This study assessed whether adding trimetazidine (TMZ) or TMZ/allopurinol to standard hydration reduces CA-AKI among elective PCI patients.</p> Methods <p>129 patients undergoing elective PCI were randomized into three groups: Group 1 received (IV isotonic saline + TMZ + allopurinol), Group 2 received (IV isotonic saline + TMZ), and Group 3 (control) received (IV isotonic saline only). The primary outcome was the incidence of CA-AKI at 24- and 48-hour post-PCI. Risk was stratified using the Mehran and the Age, Creatinine, and Ejection Fraction (ACEF) scores.</p> Results <p>Group 1 demonstrated a non-significant reduction in CA-AKI incidence compared with Groups 2 and 3 (24&#xa0;h: 4.65%, 4.55%, and 9.52%; 48&#xa0;h: 16.28%, 20.45%, and 28.57%; <i>p</i> &gt; 0.05). All patients were classified as low–moderate risk by ACEF and Mehran scores, neither of which predicted CA-AKI. At 48&#xa0;h, SGLT2 inhibitors users demonstrated a smaller rise in creatinine compared with non-users (–0.04 ± 0.158&#xa0;mg/dL vs. 0.096 ± 0.237&#xa0;mg/dL, <i>p</i> &lt; 0.05), as did DPP-4 inhibitor users (–0.05 ± 0.217&#xa0;mg/dL vs. +0.098 ± 0.237&#xa0;mg/dL, <i>p</i> &lt; 0.05). Diuretics were associated with greater increases (<i>p</i> &lt; 0.05).</p> Conclusion <p>The TMZ–allopurinol combination showed a favorable but non-significant trend toward reducing CA-AKI, while ACEF and Mehran scores demonstrated limited predictive value. Improved risk-stratification tools and larger studies in higher-risk patients are needed. SGLT2 and DPP-4 inhibitors showed smaller creatinine increases, suggesting possible nephroprotection, but this remains exploratory.</p>

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Trimetazidine and allopurinol for the prevention of Contrast-associated acute kidney injury in elective percutaneous coronary intervention: a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月22日

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  • Nourhan Osama Ali,
  • Naglaa Samir Bazan,
  • Hatem Hossam Mowafy,
  • Mohamed E.A. Abdelrahim,
  • Hadeer S. Harb

摘要

Purpose

Contrast-associated acute kidney injury (CA-AKI) is a significant concern following percutaneous coronary intervention (PCI). This study assessed whether adding trimetazidine (TMZ) or TMZ/allopurinol to standard hydration reduces CA-AKI among elective PCI patients.

Methods

129 patients undergoing elective PCI were randomized into three groups: Group 1 received (IV isotonic saline + TMZ + allopurinol), Group 2 received (IV isotonic saline + TMZ), and Group 3 (control) received (IV isotonic saline only). The primary outcome was the incidence of CA-AKI at 24- and 48-hour post-PCI. Risk was stratified using the Mehran and the Age, Creatinine, and Ejection Fraction (ACEF) scores.

Results

Group 1 demonstrated a non-significant reduction in CA-AKI incidence compared with Groups 2 and 3 (24 h: 4.65%, 4.55%, and 9.52%; 48 h: 16.28%, 20.45%, and 28.57%; p > 0.05). All patients were classified as low–moderate risk by ACEF and Mehran scores, neither of which predicted CA-AKI. At 48 h, SGLT2 inhibitors users demonstrated a smaller rise in creatinine compared with non-users (–0.04 ± 0.158 mg/dL vs. 0.096 ± 0.237 mg/dL, p < 0.05), as did DPP-4 inhibitor users (–0.05 ± 0.217 mg/dL vs. +0.098 ± 0.237 mg/dL, p < 0.05). Diuretics were associated with greater increases (p < 0.05).

Conclusion

The TMZ–allopurinol combination showed a favorable but non-significant trend toward reducing CA-AKI, while ACEF and Mehran scores demonstrated limited predictive value. Improved risk-stratification tools and larger studies in higher-risk patients are needed. SGLT2 and DPP-4 inhibitors showed smaller creatinine increases, suggesting possible nephroprotection, but this remains exploratory.