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

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.