Silymarin for the Prevention of Contrast-Induced Nephropathy after Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction

Document Type : Original Article

Abstract

Background: Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures, increasing morbidity and mortality. Oxidative stress and inflammation play key roles in its pathogenesis. Silymarin, a flavonoid complex with antioxidant and anti-inflammatory properties, may offer renal protection.
Objective: To assess the protective effect of a single dose of silymarin against CIN in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
Patients and Methods: In this prospective interventional study, 200 STEMI patients undergoing PPCI were randomized into two equal groups. The study group received 140 mg of silymarin alongside standard dual antiplatelet therapy, while the control group received standard therapy alone. Renal function was assessed at baseline and post-procedure using serum creatinine and estimated glomerular filtration rate (eGFR). CIN was defined as a ≥25% increase in serum creatinine or an absolute rise of ≥0.5 mg/dL within 48–72 hours post-contrast exposure.
Results: CIN incidence was significantly lower in the silymarin group (12.0% vs. 28.0%, p = 0.005). Post-procedural serum creatinine increase was smaller (ΔS. Creat: 0.18 ± 0.28 vs. 0.35 ± 0.42 mg/dL, p = 0.011), with a lesser eGFR reduction (ΔGFR: -8.63 ± 17.43 vs. -18.21 ± 23.95 mL/min, p < 0.001). Contrast volume and procedural duration were higher in the study group (p < 0.001, p = 0.003).
Conclusion: A single dose of silymarin significantly reduced CIN incidence in STEMI patients undergoing PPCI, highlighting its potential nephroprotective effect in high-risk populations.
 

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The Egyptian Journal of Hospital Medicine
Volume 98, Issue 1
January 2025
Pages 971-976

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