The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this study is to examine the efficacy of the prostacyclin analogue iloprost (dose 1ng/kg/min) in preventing CMN in high-risk patients undergoing a coronary procedure.

Inclusion Criteria:

• Patients undergoing clinically driven, non-emergent coronary angiography or intervention in our institution were eligible for inclusion if their serum creatinine concentration was ≥1.4 mg/dl (124 μmol/l) and/or their creatinine clearance was <60 ml/min on their most recent sample drawn within 1 month of the planned procedure

Exclusion Criteria:

• Circulatory shock for any reason, systolic blood pressure <95 mm Hg
• Known acute renal failure
• End-stage renal disease requiring dialysis
• Intravascular administration of a contrast medium within the previous 10 days
• Anticipated re-administration of contrast medium within the following 6 days
• Inability to administer intravenous hydration at least 4 h before the procedure or study medication at least 30 min before the procedure
• Primary intervention for acute infarction with ST elevation
• A procedure performed within 2 h of acute hospital admission