Khan Sher Ali, Campbell Ashley M, Lu Yingying, An Lingling, Alpert Joseph S, Chen Qin M
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, United States.
Graduate Interdisciplinary Program in Statistics and Data Science, University of Arizona, Tucson, AZ, United States.
Front Cardiovasc Med. 2021 Nov 19;8:752939. doi: 10.3389/fcvm.2021.752939. eCollection 2021.
Coronary artery reperfusion is essential for the management of symptoms in the patients with myocardial ischemia. However, the benefit of reperfusion often comes at an expense of paradoxical injury, which contributes to the adverse events, and sometimes heart failure. Reperfusion is known to increase the production of reactive oxygen species (ROS). We address whether N-acetylcysteine (NAC) reduces the ROS and alleviates reperfusion injury by improving the clinical outcomes. A literature search for the randomized controlled trials (RCTs) was carried out in the five biomedical databases for testing the effects of NAC in patients undergoing coronary artery reperfusion by percutaneous coronary intervention, thrombolysis, or coronary artery bypass graft. Of 787 publications reviewed, 28 RCTs were identified, with a summary of 2,174 patients. A meta-analysis using the random effects model indicated that NAC administration during or prior to the reperfusion procedures resulted in a trend toward a reduction in the level of serum cardiac troponin (cTn) [95% , standardized mean difference (SMD) -0.80 (-1.75; 0.15), = 0.088, = 262 for control, 277 for NAC group], and in the incidence of postoperative atrial fibrillation [95% , relative risk (RR) 0.57 (0.30; 1.06), = 0.071, = 484 for control, 490 for NAC group]. The left ventricular ejection fraction or the measures of length of stay in intensive care unit (ICU) or in hospital displayed a positive trend that was not statistically significant. Among the nine trials that measured ROS, seven showed a correlation between the reduction of lipid peroxidation and improved clinical outcomes. These lines of evidence support the potential benefit of NAC as an adjuvant therapy for cardiac protection against reperfusion injury.
冠状动脉再灌注对于心肌缺血患者症状的管理至关重要。然而，再灌注的益处往往以矛盾性损伤为代价，这种损伤会导致不良事件，有时还会引发心力衰竭。已知再灌注会增加活性氧（ROS）的产生。我们探讨了N-乙酰半胱氨酸（NAC）是否能通过改善临床结局来减少ROS并减轻再灌注损伤。在五个生物医学数据库中进行了文献检索，以测试NAC对接受经皮冠状动脉介入治疗、溶栓或冠状动脉旁路移植术进行冠状动脉再灌注患者的影响。在审查的787篇出版物中，确定了28项随机对照试验（RCT），共纳入2174例患者。使用随机效应模型进行的荟萃分析表明，在再灌注过程中或之前给予NAC会使血清心肌肌钙蛋白（cTn）水平有降低的趋势[95%置信区间，标准化均数差（SMD）为-0.80（-1.75；0.15），P = 0.088，对照组为262例，NAC组为277例]，并且术后房颤的发生率也有降低趋势[95%置信区间，相对危险度（RR）为0.57（0.30；1.06），P = 0.071，对照组为484例，NAC组为490例]。左心室射血分数或重症监护病房（ICU）或住院时间的测量结果显示出积极趋势，但无统计学意义。在测量ROS的九项试验中，七项显示脂质过氧化的减少与临床结局改善之间存在相关性。这些证据支持了NAC作为辅助治疗预防心脏再灌注损伤的潜在益处。
