A Double-Blind, Randomized Clinical Trial Comparing Cardioprotective Effects of N-acetylcysteine and Glucose-Insulin-Potassium as an Additive to Cardioplegia during Coronary Artery Bypass Grafting

Optimum conditions for many coronary artery bypass graft surgeries (CABG) necessitate the heart to be prevented from beating. Cardioplegic solution and its ingredients are thus of utmost importance in cardioprotection. An ideal protection will help the heart return into its normal function after CABG. This research compared the cardioprotective effects of adding either N-acetylcysteine (NAC) to Cardioplegic solution with infusion of glucose-insulin-potassium (GIK) in patients with low ejection fraction (EF). In a double-blind randomized clinical trial, 60 elective CABG patients with EF < 50% were evaluated. The patients were numbered according to their reference to the Heart Center of Mazandaran (Iran) and their arrangements in the operation list. They were randomly allocated to 2 groups of 30 by a computer program to receive either GIK (group G) or NAC (group N). Compared to group G, group N had significantly lower incidence of arrhythmia during and after the operation (p = 0.041). They also needed lower doses of inotropic medications after the termination of cardiopulmonary bypass (CPB) (p = 0.041). The 2 groups were not significantly different in the need for shock or pacemaker after CPB and using pacemakers and inotropic drugs in the intensive care unit. Changes in mean EF from before to after the operation were 0.87 +/- 0.85% in group N and -2.24 +/- 1.02% in group G (p = 0.012). The mean troponin I levels were 0.406 +/- 0.316, 0.41 +/- 0.512 in groups N and G, respectively (p = 0.41). NAC seems to be more beneficial than GIK for protecting myocardial cells, decreasing threatening signs of patients, especially arrhythmia, and increasing EF after CABG. It would probably decrease the mortality risk associated with arrhythmias. [Mohammad Reza Habibi, Shervin Ziabakhsh-Tabari, Alireza Khalilian, Samira Rahemi, Rozita Jalalian. A Double-Blind, Randomized Clinical Trial Comparing Cardioprotective Effects of N-acetylcysteine and Glucose-Insulin-Potassium as an Additive to Cardioplegia during Coronary Artery Bypass Grafting. Life Sci J 2012;9(4):3126-3130] (ISSN:1097-8135). http://www.lifesciencesite.com. 457