The online version of this article (doi:10.1186/1471-2261-14-52) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
LXH conceived the study, participated in the design, collected the data, performed statistical analyses and drafted the manuscript. XCY helped to collect data. FGH conceived the study, participated the design. All authors read and approved the final manuscript.
Atrial fibrillation is a common complication after cardiac surgery. The aim of this study is to evaluate whether N-acetylcysteine (NAC) could prevent postoperative atrial fibrillation (POAF).
PubMed, Embase and Cochrane Center Register of Controlled Trials were searched from the date of their inception to 1 July 2013 for relevant randomized controlled trials (RCTs), in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF, all-cause mortality, length of intensive care unit (ICU) stay, hospital length of stay, and the incidence of cerebrovascular events. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.
We retrieved ten studies enrolling a total of 1026 patients. Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital. No difference in the incidence of cerebrovascular events was observed.
Prophylactic use of NAC could reduce the incidence of POAF and all-cause mortality in adult patients undergoing cardiac surgery. However, larger RCTs evaluating these and other postoperative complication endpoints are needed.
Likosky DS, Leavitt BJ, Marrin CA, Malenka DJ, Reeves AG, Weintraub RM, Caplan LR, Baribeau YR, Charlesworth DC, Ross CS, Braxton JH, Hernandez F, O'Connor GT: Intra- and postoperative predictors of stroke after coronary artery bypass grafting. Ann Thorac Surg. 2003, 76: 428-434. 10.1016/S0003-4975(03)00490-9. discussion 435 CrossRefPubMed
Kim MH, Deeb GM, Morady F, Bruckman D, Hallock LR, Smith KA, Karavite DJ, Bolling SF, Pagani FD, Wahr JA, Sonnad SS, Kazanjian PE, Watts C, Williams M, Eagle KA: Effect of postoperative atrial fibrillation on length of stay after cardiac surgery (The Postoperative Atrial Fibrillation in Cardiac Surgery study [PACS(2)]. Am J Cardiol. 2001, 87: 881-885. 10.1016/S0002-9149(00)01530-7. CrossRefPubMed
Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS, Smith SC, Priori SG, Estes NA, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Jacobs AK, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson WG, Tarkington LG, Yancy CW, et al: ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011, 2011 (123): e269-e367. CrossRef
Sabol F, Jakubova M, Mitro P, Bomba A, Chmelarova A, Petrasova D, Stancak B, Nagy V, Torok P, Sebova A: Is there a relationship between inflammatory markers, oxidative stress and postoperative atrial fibrillation?. Vnitr Lek. 2012, 58: 730-734. PubMed
Kazemi B, Akbarzadeh F, Safaei N, Yaghoubi A, Shadvar K, Ghasemi K: Prophylactic high-dose Oral-N-Acetylcysteine does not prevent atrial fibrillation after heart surgery: a prospective double blind placebo-controlled randomized clinical trial. Pacing Clin Electrophysiol. 2013, 36: 1211-1219. PubMed
Ozaydin M, Icli A, Yucel H, Akcay S, Peker O, Erdogan D, Varol E, Dogan A, Okutan H: Metoprolol vs. carvedilol or carvedilol plus N-acetylcysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study. Eur Heart J. 2013, 34: 597-604. 10.1093/eurheartj/ehs423. CrossRefPubMed
Peker O, Peker T, Erdogan D, Ozaydin M, Kapan S, Sutcu R, Ibrisim E: Effects of intravenous N-acetylcysteine on periprocedural myocardial injury after on-pump coronary artery by-pass grafting. J Cardiovasc Surg (Torino). 2008, 49: 527-531.
El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, Cartier R, Page P, Perrault LP: Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg. 2007, 133: 7-12. 10.1016/j.jtcvs.2006.05.070. CrossRefPubMed
Haase M, Haase-Fielitz A, Bagshaw SM, Reade MC, Morgera S, Seevenayagam S, Matalanis G, Buxton B, Doolan L, Bellomo R: Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients. Crit Care Med. 2007, 35: 1324-1331. 10.1097/01.CCM.0000261887.69976.12. CrossRefPubMed
Carnes CA, Chung MK, Nakayama T, Nakayama H, Baliga RS, Piao S, Kanderian A, Pavia S, Hamlin RL, McCarthy PM, Bauer JA, Van Wagoner DR: Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation. Circ Res. 2001, 89: E32-E38. 10.1161/hh1801.097644. CrossRefPubMed
- Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials
- BioMed Central
Neu im Fachgebiet Kardiologie
Mail Icon II