N-acetylcysteine and magnesium improve biochemical abnormalities associated with myocardial ischaemic reperfusion in South Indian patients undergoing coronary artery bypass grafting: a comparative analysis.
BACKGROUND
The clinical presentation of ischaemic reperfusion in postoperative patients correlates with oxidative stress. The limited clinical success of anti-ischaemic reperfusion agents has prompted a comparison of the efficacy of N-acetylcysteine (NAC) and magnesium (Mg) in South Indian patients undergoing coronary artery bypass grafting (CABG).


METHODS
In Clinical Trial I, 52 South Indian patients who had undergone CABG surgery (with intraoperative Mg supplementation) and 40 controls (without Mg supplementation) were selected and matched. The control patients underwent the same protocol without Mg. In Clinical Trial II, the study population consisted of 50 patients, where 25 patients received NAC just before the release of the aortic cross clamp. In the NAC untreated group, dextrose solution was administered at the same time as the placebo. Six blood samples were taken at different times during the cardiac surgery and the antioxidant enzymes, ATPase and cardiac markers from the coronary sinus blood samples were analysed.


RESULTS
Increased blood lipid peroxidation was observed in patients who were not treated with Mg/NAC. The administration of Mg/NAC just before the release of the aortic cross clamp reduced the lipid peroxidation significantly (p-value is less than 0.05). The above observations were supported by the antioxidant enzyme levels. Significant improvements to the erythrocyte ATPase and cardiac markers in patients treated with Mg/NAC correlated with a reduction in postoperative abnormalities. Based on the biochemical status of the patients, Mg was shown to mediate better recovery from postoperative changes.


CONCLUSIONS
NAC and Mg decreased pump-induced oxidative stress during cardiopulmonary bypass (CPB), suggesting that it could be a novel therapy for assisting in the prevention of CPB-induced oxidative stress.
Kurian
G A
GA
MMM Academy of Medical Sciences, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A Jayalalithanagar, Mogappair, Chennai 600037, India. ginokurian@hotmail.com
Paddikkala
J
J
D000111:Acetylcysteine / Q000627:therapeutic use*; D000251:Adenosine Triphosphatases / Q000097:blood; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D005609:Free Radicals / Q000378:metabolism; D006801:Humans; D007194:India; D015227:Lipid Peroxidation / Q000187:drug effects; D017616:Magnesium Compounds / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000188:drug therapy* / Q000209:etiology; D018384:Oxidative Stress / Q000187:drug effects; D011183:Postoperative Complications; D017392:Thiobarbituric Acid Reactive Substances / Q000032:analysis
D015415:Biomarkers; D016166:Free Radical Scavengers; D005609:Free Radicals; D017616:Magnesium Compounds; D017392:Thiobarbituric Acid Reactive Substances; D000251:Adenosine Triphosphatases; D000111:Acetylcysteine