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.
BACKGROUND
The aims of this preliminary study were to determine the alteration of serum ischemia-modified albumin (IMA) levels and to investigate whether IMA may be used as an indicator of the cardioprotective efficacy of N-acetylcysteine (NAC) in patients undergoing coronary bypass grafting (CABG).


METHODS
Forty-four patients were randomized into one of two groups on the basis of cardioplegic strategies, either cold-blood cardioplegia enriched with NAC (50 mg/kg) or cold-blood cardioplegia alone. Serum IMA, cardiac troponin T (cTnT) and malondialdehyde (MDA) levels determined in NAC-enriched patients before and after CABG were compared with those of the NAC-free group. The albumin cobalt binding assay was used for IMA determination.


RESULTS
Serum IMA levels were significantly elevated after cross-clamping and peaked at 6 h after reperfusion in the two groups. In NAC-enriched patients, IMA levels determined 6, 12, 24 and 48 h after reperfusion were significantly lower than those of the NAC-free group (p < or = 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IMA returned to baseline 24 h after reperfusion differently from cTnT and MDA in the NAC-enriched group.


CONCLUSIONS
IMA may be used as not only an indicator of myocardial ischemia-reperfusion injury, but also as a useful indicator of the cardioprotective effect of NAC in CABG.
Karahan
S Caner
SC
Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University, TR-61080 Trabzon, Turkey. scaner61@yahoo.com
Koramaz
Ismail
I
Altun
Gokalp
G
Uçar
Utku
U
Topbaş
Murat
M
Menteşe
Ahmet
A
Kopuz
Muge
M
D000111:Acetylcysteine / Q000627:therapeutic use*; D000418:Albumins / Q000378:metabolism*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003080:Cold Temperature; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008315:Malondialdehyde; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D020107:Troponin T / Q000097:blood
D000418:Albumins; D002316:Cardiotonic Agents; D020107:Troponin T; D008315:Malondialdehyde; D000111:Acetylcysteine