Why the study?
Postoperative atrial fibrillation is common after cardiovascular surgery, and the combination of N-acetylcysteine and beta-blockers targeting inflammation required evaluation for efficacy in preventing it compared to beta-blockers alone.
Does N-acetylcysteine plus beta-blocker reduce postoperative atrial fibrillation in cardiac surgery patients compared to beta-blocker alone?
Does N-acetylcysteine plus beta-blocker reduce postoperative atrial fibrillation in cardiac surgery patients compared to beta-blocker alone?
The addition of N-acetylcysteine to beta-blocker therapy significantly reduces the risk of postoperative atrial fibrillation in patients undergoing cardiac surgery.
Supports adding NAC to BB for POAF prevention after cardiac surgery; extends prior trial evidence via meta-analysis.
Background: Postoperative atrial fibrillation (POAF) is the most common arrythmia to occur after cardiovascular surgery. Inflammation being pivotal in POAF perpetuation has been utilized as a therapeutic target. Owing to their anti-inflammatory and anti-oxidant effects, beta-blockers (BB) and N-acetylcysteine (NAC) became research interests in the pursuit for an effective POAF prevention strategy. Objective: To determine the efficacy of NAC plus BB versus BB alone in preventing POAF in cardiac surgery patients. Methodology: A literature search using the following search engines: PubMed/Medline, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley and Google Scholar for relevant randomized trials were conducted. Published and unpublished studies indexed from inception until 2023 were included. Three independent reviewers evaluated the randomized clinical trials (RCTs) for eligibility. The pooled estimates for POAF prevention as primary outcome and MACE, mortality, myocardial infarction, stroke, ICU LOS and hospital LOS as secondary outcomes were measured using the RStudio statistical software. Results: Seven eligible RCTs allocated 1069 cardiac surgery patients to NAC + BB (n=539) and BB alone (N = 530) treatment arms. The effect estimate using random effect model disclosed significantly reduced POAF events (RR 0.62, 95% CI [0.44, 0.86], p = 0.005) in those on NAC + BB. While no statistical difference between the study arms were demonstrated in reducing mortality (RR 0.63, 95% CI [0.23, 1.73], p = 0.37); myocardial infarction (RR 1.02, 95% CI [0.49, 2.13], p = 0.96); stroke (RR 0.95, 95% CI [0.24, 3.68], p = 0.94); ICU LOS (std. mean difference 0.14, 95% CI [-0.43, 0.70], p = 0.41), and hospital LOS (std. mean difference 0.08, 95% CI [-0.06, 0.21], p = 0.19). Conclusion: Among cardiac surgery patients, the use of NAC in combination with BB compared with BB alone significantly reduced POAF.
No takes yet. Share an insight, caveat, or question.
Vista et al. (2025) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: