Evaluating the Effect of Intracoronary N-Acetylcysteine on Platelet Activation Markers After Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction.
During percutaneous coronary intervention (PCI), trauma occurs in the arterial endothelium, resulting in platelet activation and aggregation. As platelet aggregation may lead to coronary thrombosis, antiplatelet agents are essential adjunctive therapies in patients undergoing PCI. The aim of this study was to determine the effect of the intracoronary administration of high-dose N-acetylcysteine (NAC) for the evaluation of its antiplatelet effects in human subjects. In this triple-blind trial, 147 patients undergoing primary PCI were enrolled. Finally, 100 patients were randomized to receive high-dose intracoronary NAC (100 mg/kg bolus, followed by 10 mg·kg⁻¹·h⁻¹ intracoronary continued intravenously for 12 hours) (n = 50) or dextrose solution (n = 50). Platelet activation biomarkers were measured before and 24 hours after the procedure. Secondary end points, comprising all-cause death, reinfarction, and target-vessel revascularization, were assessed at 30 days and 2 years. In comparison with the placebo, NAC could not reduce the level of platelet activation biomarkers within a 24-hour period after its prescription. Major adverse clinical events at 30 days and 2 years were infrequent and not statistically different between the 2 groups. Our results revealed that NAC, compared with the placebo, did not provide an additional clinical benefit as an effective antiplatelet agent after PCI.
1Department of Pharmacology and Toxicology, Faculty of Pharmacy-International Campus, Iran University of Medical Sciences, Tehran, Iran; 2Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Pharmaceutical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; 4Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 5Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; 6Cardiology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran; 7Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; and 8Department of Molecular Pathology, Tehran Heart Center, Tehran, Iran.
Azadeh
A
Eshraghi
Azita Hajhossein
AH
Talasaz
Jamshid
J
Salamzadeh
Mojtaba
M
Salarifar
Hamidreza
H
Pourhosseini
Yones
Y
Nozari
Mostafa
M
Bahremand
Arash
A
Jalali
Mohammad Ali
MA
Boroumand
D000111:Acetylcysteine / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D015415:Biomarkers; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*
D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D000111:Acetylcysteine