Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: a meta-analysis

Abstract

Post-cardiothoracic surgery (CTS) complications (e.g. myocardial injury, renal dysfunction, atrial fibrillation) may occur as a result of enhanced systemic inflammation, perhaps provoked by an oxidative stress response. N-acetylcysteine (NAC) is a free radical scavenger antioxidant agent that may attenuate this physiologic response and reduce post-CTS complications. Thus, a meta-analysis was performed to help characterize the potential beneficial effects of perioperative NAC administration in patients undergoing CTS. A systematic literature search in MEDLINE, EMBASE and the Cochrane Library was conducted through April 2008. A search strategy using medical subject headings and text keywords was performed. Results are reported as odds ratios or weighted mean differences with accompanying 95% confidence intervals (CIs). Studies were pooled using a fixed-effect model. The primary outcomes included atrial fibrillation (AF), myocardial infarction (MI), stroke, acute kidney injury (AKI), need for renal replacement therapy (RRT), mortality and total hospital length-of-stay (LOS). Upon meta-analysis of 13 trials (n=1338 subjects), the use of NAC appeared to statistically significantly lower the odds of developing post-CTS AF by 36% (95%CI 2-58%) (n=6 studies). This corresponded to an 8% (1-15%) pooled risk difference and a number-needed-to-treat of 13. NAC did not appear to significantly alter any of the other meta-analysis endpoints. The exclusion of the study utilizing only oral NAC therapy and the study with lower internal validity did not affect the overall conclusions of our meta-analysis. Currently, the most compelling data for using NAC in CTS patients is in post-CTS AF prevention. However, additional, larger randomized controlled trials evaluating this and other postoperative complication endpoints are needed.

Ischemia-Modified Albumin Reduction after Coronary Bypass Surgery Is Associated with the Cardioprotective Efficacy of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine: A Preliminary Study

“…The cardioprotective efficacy of NAC in cardiac surgery has been reported in a number of recent studies [24][25][26] . However, a considerable number of studies have concluded that the use of NAC in cardiac surgery did not appear to bestow any statistically significant benefits [27,28] . In a study by Bapat et al [29] intended to determine survival and evaluate quality of life after 1 year in patients with prolonged ICU stays after cardiac surgery utilizing CABG, it was estimated that 1-year mortality in patients with prolonged ICU stays after cardiac surgery remains high.…”

Antioxidant Therapies in the Prevention and Treatment of Atrial Fibrillation

“…In a randomized study including 115 patients undergoing CABG or valve surgery, Ozaydin et al [46] demonstrated that NAC markedly reduces the incidence of POAF lasting more than 5 minutes. A previous meta-analysis [47] evaluated potential beneficial effects of perioperative NAC on the prevention of complications after cardiothoracic surgery. In the sub-group analysis of six trials which reported POAF as study endpoints, the use of NAC significantly lowered the risk of developing POAF by 36%.…”

N-acetylcysteine alleviates angiotensin II-mediated renal fibrosis in mouse obstructed kidneys

“…Acta Pharmacologica Sinica npg metal toxicity, and psychiatric disorders [24][25][26][27] . Several studies have shown that NAC could be used for the treatment of pulmonary fibrosis, liver fibrosis, and skin fibrosis [28][29][30][31] .…”