Effect of intravenous N -acetylcysteine on outcomes after coronary artery bypass surgery: A randomized, double-blind, placebo-controlled clinical trial

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 133; no. 1; pp. 7 - 12
• Main Authors: El-Hamamsy, Ismail, MD, Stevens, Louis-Mathieu, MD, Carrier, Michel, MD, Pellerin, Michel, MD, Bouchard, Denis, MD, Demers, Philippe, MD, Cartier, Raymond, MD, Page, Pierre, MD, Perrault, Louis P., MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 2007; AATS/WTSA; Elsevier
• Subjects: Acetylcysteine - administration & dosage; Administration, Oral; Adult; Aged; Anti-Inflammatory Agents - administration & dosage; Antioxidants - administration & dosage; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary Bypass; Cardiothoracic Surgery; Coronary Artery Bypass; Coronary heart disease; Double-Blind Method; Female; Heart; Humans; Injections, Intravenous; Interleukin-6 - blood; Male; Medical sciences; Middle Aged; Myocardial Reperfusion Injury - prevention & control; Postoperative Complications; Preoperative Care; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; 25; NS; CK-MB; IL-6; N-acetylcysteine; interleukin 6; NAC; CPB; ROS; reactive oxygen species; cardiopulmonary bypass; not significant; creatine kinase; ICU; intensive care unit; CABG; 31; coronary artery bypass grafting; Heart; Thiol; Prognosis; Intravenous administration; Acetylcysteine; Cardiovascular disease; Thorax; Antioxidant; Coronary heart disease; Mucolytic; Randomization; Coronary artery bypass; Double blind study; Evolution
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2006.05.070

Objective N -acetylcysteine, a potent anti-inflammatory and antioxidant agent, is known to decrease the production of reactive oxygen species after cardiac surgery. The objective of this study was to evaluate the effects of intravenous N -acetylcysteine on clinical and biochemical outcomes after coronary artery bypass surgery with cardiopulmonary bypass. Methods One hundred patients (mean age 60.5 years, range 43-78 years, 89% male) undergoing coronary artery bypass grafting at the Montreal Heart Institute were randomized to receive either N -acetylcysteine (600 mg orally the day before and the morning of the operation, a bolus of 150 mg/kg of intravenous N -acetylcysteine before skin incision, followed by perfusion at 12.5 mg · kg−1 · h−1 over 24 hours; n = 50) or placebo (n = 50). The patients and clinical team were blinded to group assignments. Preoperative characteristics were similar between the two groups. Postoperative clinical data (death, myocardial infarction, low-output syndromes, arrhythmias, bleeding, transfusion requirements, and intensive care unit and hospital lengths of stay) and biochemical markers (creatine kinase MB, troponin T, creatinine, hemoglobin, and platelet levels) were evaluated serially over 4 days. Results Clinical outcomes were not significantly different between the two groups with regard to the incidence of death, myocardial infarction, bleeding, transfusion requirements, intubation time, and hospital length of stay. No differences were found in postoperative biochemical markers (troponin T, creatine kinase MB, creatinine, hemoglobin, and platelets) between the groups. No differences were observed between the groups in interleukin-6 production ( P = not significant). Conclusions Prophylactic use of N -acetylcysteine in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass does not lead to improvement in clinical results or biochemical markers. Further strategies to decrease reperfusion injury should be devised.