Ischemia-Modified Albumin Reduction after Coronary Bypass Surgery Is Associated with the Cardioprotective Efficacy of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine: A Preliminary Study

Abstract

Background: The aims of this preliminary study were to determine the alteration of serum ischemia-modified albumin (IMA) levels and to investigate whether IMA may be used as an indicator of the cardioprotective efficacy of N-acetylcysteine (NAC) in patients undergoing coronary bypass grafting (CABG). Patients and Methods: Forty-four patients were randomized into one of two groups on the basis of cardioplegic strategies, either cold-blood cardioplegia enriched with NAC (50 mg/kg) or cold-blood cardioplegia alone. Serum IMA, cardiac troponin T (cTnT) and malondialdehyde (MDA) levels determined in NAC-enriched patients before and after CABG were compared with those of the NAC-free group. The albumin cobalt binding assay was used for IMA determination. Results: Serum IMA levels were significantly elevated after cross-clamping and peaked at 6 h after reperfusion in the two groups. In NAC-enriched patients, IMA levels determined 6, 12, 24 and 48 h after reperfusion were significantly lower than those of the NAC-free group (p ≤ 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IMA returned to baseline 24 h after reperfusion differently from cTnT and MDA in the NAC-enriched group. Conclusions: IMA may be used as not only an indicator of myocardial ischemia-reperfusion injury, but also as a useful indicator of the cardioprotective effect of NAC in CABG.

Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery

“…Karahan et al investigated the effectiveness of cold blood with added anti-oxidant (N-acetyl cysteine, NAC) cardioplegia on myocardial protection by measuring serum IMA level. 25) Similar to our study, they noticed that serum IMA level was significantly lesser increase in the NAC than the other group, could show myocardial damage, and could be used in follow-up to affect cardioplegia on myocardial protection. Unlike their study, there was a comparison on colloid cardioplegia with crystalloid cardioplegia instead of two colloid cardioplegia.…”

N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials

“…Among the 29 eligible RCTs, trials took place in a variety of settings (S5 Table) including Turkey [20, 53, 54, 59, 60, 63, 66, 67, 69, 70], Canada [56, 58, 79], United States of America [52, 55], Finland [73, 78], Germany [61], Italy [75], Belgium [57], India [68, 71, 72], South Korea [65, 77], Iran [64, 76], Brazil [74] and Australia [62]. Sample sizes ranged from 18 [57] to 295 [56] participants (S5 Table).…”

Is the Measurement of Serum Ischemia-Modified Albumin the Best Test to Diagnose Ovarian Torsion?

“…This measurement has been described in detail in our previous study [4]. In our laboratory, the albumin-binding capacity assay within-run percent coefficient of variation (CV%) of patient samples averaged 2.1% [11]. IMA has a short half-life, returning to baseline values in 6-12 h [12].…”

“…In our laboratory, the MDA assay within-run CV% of patient samples averaged 1.9% [11]. MDA half-life may be as long as 4 min in the presence of oxygen [14].…”