N‐Acetylcysteine as an additive to crystalloid cardioplegia increased oxidative stress capacityin CABG patients

Abstract

Objective—This prospective, randomized study was designed to assess the effects of N‐acetylcysteine (NAC) in coronary artery bypass graft (CABG) patients.Design—Thirty‐five consenting CABG patients with normal myocardial function were randomly divided into control (C) patients (N = 20) who received crystalloid (Plegisol®) cardioplegia, and NAC patients receiving NAC in a 0.04 mol/l solution (N = 15) in Plegisol®. Simultaneous coronary sinus and aortic blood samples, and myocardial biopsies were taken 1, 5 and 10 min after declamping. Hemodynamics was measured invasively for 24 h.Results—There were no adverse effects observed. The myocardial glutathione content was significantly better preserved (p = 0.0001) and myeloperoxidase activity was over two times lower in the NAC group than in the C group (p = 0.03). The trap capacity gradient between the aorta and the coronary sinus increased significantly during the first minute of reperfusion in the treatment group (p = 0.001) when compared with the C group. In the first minute after reperfusion there were more leukocytes sequestered in the coronary circulation (p = 0.04) in the C group. The invasive hemodynamic data did not differ significantly between the groups. The incidence of arrhythmias was equal.Conclusion—NAC increased tissue capacity against oxidative stress and decreased inflammatory response in CABG patients with normal ejection fraction.