not-yet-known not-yet-known not-yet-known unknown Objectives: Contrast-associated acute kidney injury (CA-AKI) is a worrying concern following percutaneous coronary interventions (PCI). This study aimed to compare hydration with trimetazidine (TMZ) plus allopurinol versus hydration alone in prevention of CA-AKI in patients undergoing elective PCI. Methods: Patients undergoing elective PCI in a prospective, randomized controlled study were included. Group 1 TMZ plus Allopurinol (n = 43) received hydration with TMZ plus Allopurinol, and Group 2 control (n = 42) received hydration. Before the procedure and up to 24 hours following the procedure, patients were administered 35 mg TMZ twice daily, and 300 mg allopurinol once daily 5 hours prior to the procedure and on the day of the procedure. The incidence of CA-AKI at 24- and 48-hours following exposure to Contrast Media was the main outcome. Risk stratification of CA-AKI was done based on Mehran score. Results: The incidence of CA-AKI was lower in TMZ plus allopurinol group compared to control group at 24 hrs and 48 hrs post-PCI; however, this did not reach statistical significance (4.7%, 16.3% versus 10%, 28.6%, P = 0.347 p = 0.174, respectively). Risk of CA-AKI was comparable based on Mehran score and was either low or moderate in both groups. Conclusion: TMZ plus allopurinol failed to produce a significant reduction of CA-AKI in patients with glomerular filtration rates (eGFR) > 60 ml/min, and low or moderate Mehran score undergoing elective PCI. The results encourage the conduct of future studies with a larger sample size in patients with high Mehran risk scores