Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center
BACKGROUND: Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this.
OBJECTIVES: Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury.
METHODS: We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose). We measured differences in peak creatine kinase-myocardial band (CK-MB) concentration, highly sensitive troponin T (hs-TnT), thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and corrected thrombolysis in myocardial infarction frame count (cTFC).
RESULTS: The peak CK-MB level was comparable between the two groups (P = 0.327), but patients receiving high-dose NAC demonstrated a significantly larger reduction in hs-TnT (P = 0.02). In total, 94% of the NAC group achieved TIMI flow grade 3 versus 80% of the control group (P = 0.03). No significant differences were observed between the two groups in terms of changes in the cTFC and MBG.
CONCLUSIONS: In this study, NAC improved myocardial reperfusion markers and coronary blood flow, as revealed by differences in peak hs-TnT and TIMI flow grade 3 levels, respectively. Further studies with large samples are warranted to elucidate the role of NAC in this population. ClinicalTrials.gov identifier: NCT01741207, and the Iranian Registry of Clinical Trials (IRCT; http://irct.ir ) registration number: IRCT201301048698N8.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
American journal of cardiovascular drugs : drugs, devices, and other interventions - 18(2018), 3 vom: 10. Juni, Seite 213-221 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nozari, Younes [VerfasserIn] |
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| Links: |
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| Themen: |
Acetylcysteine |
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| Anmerkungen: |
Date Completed 25.09.2018 Date Revised 25.09.2018 published: Print ClinicalTrials.gov: NCT01741207 Citation Status MEDLINE |
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| doi: |
10.1007/s40256-017-0258-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM279849680 |
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| 245 | 1 | 0 | |a Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center |
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| 500 | |a ClinicalTrials.gov: NCT01741207 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this | ||
| 520 | |a OBJECTIVES: Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury | ||
| 520 | |a METHODS: We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose). We measured differences in peak creatine kinase-myocardial band (CK-MB) concentration, highly sensitive troponin T (hs-TnT), thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and corrected thrombolysis in myocardial infarction frame count (cTFC) | ||
| 520 | |a RESULTS: The peak CK-MB level was comparable between the two groups (P = 0.327), but patients receiving high-dose NAC demonstrated a significantly larger reduction in hs-TnT (P = 0.02). In total, 94% of the NAC group achieved TIMI flow grade 3 versus 80% of the control group (P = 0.03). No significant differences were observed between the two groups in terms of changes in the cTFC and MBG | ||
| 520 | |a CONCLUSIONS: In this study, NAC improved myocardial reperfusion markers and coronary blood flow, as revealed by differences in peak hs-TnT and TIMI flow grade 3 levels, respectively. Further studies with large samples are warranted to elucidate the role of NAC in this population. ClinicalTrials.gov identifier: NCT01741207, and the Iranian Registry of Clinical Trials (IRCT; http://irct.ir ) registration number: IRCT201301048698N8 | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Talasaz, Azita Hajhossein |e verfasserin |4 aut | |
| 700 | 1 | |a Bahremand, Mostafa |e verfasserin |4 aut | |
| 700 | 1 | |a Salamzadeh, Jamshid |e verfasserin |4 aut | |
| 700 | 1 | |a Salarifar, Mojtaba |e verfasserin |4 aut | |
| 700 | 1 | |a Pourhosseini, Hamidreza |e verfasserin |4 aut | |
| 700 | 1 | |a Jalali, Arash |e verfasserin |4 aut | |
| 700 | 1 | |a Mortazavi, Seyedeh Hamideh |e verfasserin |4 aut | |
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