HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baker, W. L. Articles by Coleman, C. I. Search for Related Content PubMed Articles by Baker, W. L. Articles by Coleman, C. I. Related Collections Cardiac - pharmacology

Review

Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: a meta-analysis

^a University of Connecticut Schools of Pharmacy, Storrs, CT, United States
^b University of Connecticut School of Medicine, Farmington, CT, United States
^c Hartford Hospital Division of Cardiology, United States
^d Hartford Hospital Division of Drug Information, Hartford, CT, United States

Received 8 July 2008; received in revised form 4 November 2008; accepted 10 November 2008.

^_* Corresponding author. Address: University of Connecticut School of Pharmacy, Pharmacoeconomics and Outcomes Studies Group, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102-5037, United States. Tel.: +1 860 545 2096; fax: +1 860 545 2277. (Email: ccolema{at}harthosp.org).

Post-cardiothoracic surgery (CTS) complications (e.g. myocardial injury, renal dysfunction, atrial fibrillation) may occur as a result of enhanced systemic inflammation, perhaps provoked by an oxidative stress response. N-acetylcysteine (NAC) is a free radical scavenger antioxidant agent that may attenuate this physiologic response and reduce post-CTS complications. Thus, a meta-analysis was performed to help characterize the potential beneficial effects of perioperative NAC administration in patients undergoing CTS. A systematic literature search in MEDLINE, EMBASE and the Cochrane Library was conducted through April 2008. A search strategy using medical subject headings and text keywords was performed. Results are reported as odds ratios or weighted mean differences with accompanying 95% confidence intervals (CIs). Studies were pooled using a fixed-effect model. The primary outcomes included atrial fibrillation (AF), myocardial infarction (MI), stroke, acute kidney injury (AKI), need for renal replacement therapy (RRT), mortality and total hospital length-of-stay (LOS). Upon meta-analysis of 13 trials (n = 1338 subjects), the use of NAC appeared to statistically significantly lower the odds of developing post-CTS AF by 36% (95%CI 2–58%) (n = 6 studies). This corresponded to an 8% (1–15%) pooled risk difference and a number-needed-to-treat of 13. NAC did not appear to significantly alter any of the other meta-analysis endpoints. The exclusion of the study utilizing only oral NAC therapy and the study with lower internal validity did not affect the overall conclusions of our meta-analysis. Currently, the most compelling data for using NAC in CTS patients is in post-CTS AF prevention. However, additional, larger randomized controlled trials evaluating this and other postoperative complication endpoints are needed.

Key Words: N-acetylcysteine • Cardiac surgery • Antioxidant • Cardiopulmonary bypass • Meta-analysis