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Background Previous studies have proved the renal protective effects of anisodamine in patients with septic shock.The aim of this study was to investigate anisodamine for the prevention of contrast induced nephropathy (CIN) in patients with acute coronary syndrome (ACS).Methods Consecutive ACS patients undergoing elective percutaneous coronary intervention (PCI) were randomly assigned to one of two groups:patients in the anisodamine group (ANI group) were assigned to receive intravenous infusions of anisodamine by an adjusted-dose (0.1-0.2 μg·kg-1.min-1) from the PCI procedure to 24 hours after PCI,and the control group (CON group) received 0.9％ isotonic saline of the same volume.All patients were hydrated for 6 to 12hours before and 12 hours after PCI.Blood samples were taken on the day of PCI and at 24,48 and 72 hours after PCI to measure the serum creatinine (SCr).Results A total of 177 patients were involved in the study,88 in the ANI group and 89 in the CON group.In both groups,the SCr concentrations significantly increased after PCI,with the peak value occurring at 48 hours.At 72 hours,the SCr concentration in the ANI group retuned to the baseline level (P＞0.05),but the SCr concentration in CON group was still higher than baseline level (P ＜0.01).The SCr concentrations at 48 and 72 hours after PCI were much lower in the ANI group than those in the CON group (both P ＜0.01).The estimated glomerular filtration rate (eGFR) significantly decreased after PCI,the lowest value occurred at 48 hours.In the ANI group,the eGFR at 72 hours was similar to the baseline level.In the CON group,the eGFR failed to ret to baseline at 72 hours (P＜0.01).The eGFR at 24,48 and 72hours after PCI were higher in the ANI group (all P ＜0.05).The incidence of CIN in the ANI group was lower than that in the CON group within 72 hours after PCI (P＜0.05).The results of multiple Logistic regression proved that both diabetes and left ventricular ejection fraction (LVEF) were independent predictors of CIN,and treatment with anisodamine was an independent preventive factor of CIN (OR 0.369 and 95％ CI 0.171 to 0.794,P=0.011).No serious side effects were found in the ANI group.Conclusion Intravenous infusion of anisodamine during and after elective PCI may safely prevent the occurrence of CIN in ACS patients.