Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction

Abstract

Recent evidence suggests that postischemic myocardial dysfunction ("stunning") may be mediated by oxygen free radicals. Various studies have reported the beneficial effects of antioxidants in ischemia-reperfusion injury. The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment on oxidative stress, infarct size, and left ventricular (LV) function, as adjunct therapy in myocardial infarction (MI). Patients with acute MI received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with streptokinase. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. At admission, plasma MDA levels were not different between the groups. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with streptokinase significantly diminished oxidative stress and improved LV function in patients with acute MI. These encouraging results would justify the performance of a larger controlled study.

Cardiovascular Effects of N-acetylcysteine in Meconium-Induced Acute Lung Injury

“…Similarly to our findings, intravenous NAC has a tendency to increase blood pressure and heart rate in piglets during hypoxia-reoxygenation, but it takes several hours for these parameters to return to the level comparable with that in sham-treated animals (Liu et al 2010). Improved function of the left ventricle after NAC has been found also in patients with myocardial infarction (Yesilbursa et al 2006). In the meconium-instilled animals of the present study we found a higher plasma aldosterone level compared with that in the salineinstilled animals.…”

Impact of High-Dose N-Acetylcysteine Versus Placebo on Contrast-Induced Nephropathy and Myocardial Reperfusion Injury in Unselected Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…However, it also led to a more heterogeneous appearance of the infarcts with increased ventricular arrhythmias (26). In addition, there are several positive effects on platelet and vascular function (27,28). Similar to several previous trials of reperfusion injury reduction, translation of these beneficial effects into the clinical setting has been disappointing (4).…”

Oxidative Stress in Young Subjects With Acute Myocardial Infarction: Evaluation at the Initial Stage and After 12 Months

“…It is not possible to exclude that all these aspects may be related to the high prevalence of inflammatory gene polymorphism demonstrated in these young subjects with AMI. [35][36][37][38][39] The persistence of an impaired oxidative stress 12 months after AMI requires 2 different considerations: first, the use of antioxidant therapy after AMI may be advisable [40][41][42][43] ; moreover, the altered oxidative status observed much later after AMI may be present also before AMI. Regarding this latter aspect, our project of reevaluating the same AMI subjects 2 years or even later after AMI may give further information.…”