N-acetylcysteine in cardiac surgery: do the benefits outweigh the risks? A meta-analytic reappraisal

J Cardiothorac Vasc Anesth. 2011 Apr;25(2):268-75. doi: 10.1053/j.jvca.2010.04.022.

Abstract

Objective: N-acetylcysteine (NAC) reduces proinflammatory cytokines, oxygen free-radical production, and ameliorates ischemia reperfusion injury; therefore, it may theoretically reduce postoperative complications in cardiac surgery. The aim of this study was to determine, through systematic review and meta-analysis of all relevant randomized trials, whether NAC reduces mortality, morbidity, or resource utilization in cardiac surgery.

Design: Meta-analysis.

Setting: University hospitals.

Participants: A total of 1,407 patients from 15 randomized studies were included in the analysis.

Interventions: None.

Measurements and main results: All randomized trials searched up to May 2009 comparing the use of NAC versus placebo during cardiac surgery in any language and reporting at least 1 predefined outcome were included. The random effect model was used to calculate odds ratios (ORs, 95% confidence intervals [CIs]) and weighted mean differences (WMD, 95% CI) for dichotomous and continuous variables, respectively. During cardiac surgery, the use of NAC did not significantly decrease acute renal failure requiring renal replacement therapy (OR = 1.05; 95% CI, 0.52-2.11; p = 0.90), new atrial fibrillation (OR = 0.67; 95% CI, 0.37-1.22; p = 0.19), or mortality (OR = 0.81; 95% CI, 0.39-1.68; p = 0.57). There were no differences in the incidence of incremental increase in serum creatinine concentration greater than 25% above baseline (OR = 0.86; 95% CI, 0.66-1.12; p = 0.26), acute myocardial infarction (OR = 0.69; 95% CI, 0.29-1.61, p =0.39), stroke (OR = 0.78; 95% CI, 0.30-2.03; p = 0.61), red blood cell transfusion requirement (OR = 0.77; 95% CI, 0.45-1.31; p = 0.33), re-exploration (OR = 1.33; 95% CI, 0.70-2.26; p = 0.29), or postoperative drainage (WMD = 33 mL; 95% CI,-125 to 191 mL; p = 0.69) between NAC and placebo.

Conclusion: Current evidence shows that the perioperative use of NAC has no proven benefit or risk on clinically important outcomes in patients undergoing cardiac surgery.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acetylcysteine / adverse effects
  • Acetylcysteine / therapeutic use*
  • Cardiac Surgical Procedures / adverse effects*
  • Free Radical Scavengers / adverse effects
  • Free Radical Scavengers / therapeutic use
  • Humans
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Randomized Controlled Trials as Topic* / methods
  • Risk Assessment / methods
  • Risk Factors

Substances

  • Free Radical Scavengers
  • Acetylcysteine