Key result
Intravenous N-acetylcysteine cuts postoperative AF ~77% vs placebo after CABG.
Why the study?
Atrial fibrillation is a common dysrhythmia after CABG surgery and the effect of intravenous N-acetylcysteine on its prevention was evaluated.
RCT (n=150)
Double-blind
randomized
Supports perioperative IV N-acetylcysteine to lower early POAF after CABG; extends randomized evidence for antioxidant prophylaxis in cardiac surgery.
BACKGROUND: Atrial fibrillation (AF) is one of the most frequently occurring dysrhythmias after coronary artery bypass graft (CABG) surgery. AIM: The aim of this study was to evaluate the effect of intravenous N-acetylcysteine (NAC) on the prevention of AF after CABG surgery. METHODS: In a double-blind, randomised controlled trial, a total of 150 patients who were scheduled for on-pump CABG surgery were randomly assigned into two groups. In group A, patients received an intravenous NAC infusion (50 mg/kg) after induction of anaesthesia. These patients additionally received two intravenous doses of NAC on postoperative days 1 and 2. Patients in group B received normal saline (as a placebo) with the same volume, during the same time interval. During the first three days after surgery, postoperative AF (POAF) was assessed by continuous electrocardiogram monitoring; serum high-sensitivity C-reactive protein (hsCRP) level was also assessed before and three days after surgery. RESULTS: During follow-up, 17 patients (17/141, 12.1%) developed POAF. POAF occurred in four (5.6%) patients in the NAC group and 13 (18.8%) patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p = 0.02). In the multivariable logistic regression analysis, the only predictor of AF after CABG surgery was the use of NAC (OR 0.21; 95% CI 0.06-0.73; p = 0.01). Also, the hsCRP level trend in the NAC group was different from the trend in the control group (group time interaction or interaction effect) (p < 0.001). CONCLUSIONS: It seems that perioperative intravenous NAC therapy can be effectively used to reduce inflammation and the incidence of POAF after CABG surgery. The clinical trial registration number: IRCT2015040921669N1.
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Soleimani et al. (2017) conducted an RCT in Postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery (n=150). Intravenous N-acetylcysteine (NAC) vs. Placebo (normal saline) was evaluated on Incidence of postoperative atrial fibrillation (POAF) during the first three days after surgery (OR 0.23, 95% CI 0.08-0.82, p=0.02). Intravenous N-acetylcysteine significantly reduced the incidence of postoperative atrial fibrillation compared to placebo (5.6% vs 18.8%, OR 0.23) during the first three days following coronary artery bypass graft surgery.
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