Effects of N-acetylcysteine on myocardial ischemia-reperfusion injury in bypass surgery.
Myocardial ischemia-reperfusion injury may complicate coronary artery bypass grafting (CABG) operations. N-Acetylcysteine (NAC) had antioxidant and microcirculatory effects, and inhibits neutrophil aggregation. The aim of this study was to determine the effects of NAC in limiting myocardial ischemia-reperfusion injury in CABG operations. Twenty patients undergoing elective coronary bypass operation with cardiopulmonary bypass were enrolled and randomly assigned to two groups: a control group operated with a routine CABG protocol, and one where NAC was administered intravenously during the operation (NAC group). Blood samples from coronary sinus for tumor necrosis factor-alpha assay, myocardial biopsy specimens for chemiluminescent luminol, and lucigenin measurements of reactive oxygen species were taken. The luminol (specific for (*)OH, H(2)O(2), and HOCl(-) radicals) and lucigenin (specific for O(2) (*-)) levels and the difference ratios after reperfusion were significantly lower in the NAC group. Tumor necrosis factor-alpha levels increased in the control group but, in contrast, a significant decrease was detected in the NAC group (P < 0.01). Creatine kinase-MB levels at 6 and 12 hours were significantly lower in the NAC group (P = 0.02). N-Acetylcysteine has potential effects to limit ischemia reperfusion injury during CABG operations. We believe that its effects on clinical outcome may be more apparent in patients prone to ischemia-reperfusion injury.
Orhan
Gokcen
G
Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. gokcenorhan@hotmail.com
Yapici
Nihan
N
Yuksel
Meral
M
Sargin
Murat
M
Senay
Sahin
S
Yalçin
A Süha
AS
Aykaç
Zuhal
Z
Aka
Serap Aykut
SA
D000111:Acetylcysteine / Q000627:therapeutic use*; D000166:Acridines; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000097:blood / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007202:Indicators and Reagents; D018836:Inflammation Mediators / Q000097:blood; D008163:Luminescent Measurements; D008165:Luminol; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000517:prevention & control*; D018384:Oxidative Stress / Q000187:drug effects; D017382:Reactive Oxygen Species / Q000097:blood; D012107:Research Design; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000187:drug effects
D000166:Acridines; D015415:Biomarkers; D016166:Free Radical Scavengers; D007202:Indicators and Reagents; D018836:Inflammation Mediators; D017382:Reactive Oxygen Species; D014409:Tumor Necrosis Factor-alpha; C033472:10,10'-dimethyl-9,9'-biacridinium; D008165:Luminol; D052279:Creatine Kinase, MB Form; D000111:Acetylcysteine