Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center

Am J Cardiovasc Drugs. 2018 Jun;18(3):213-221. doi: 10.1007/s40256-017-0258-8.


Background: Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this.

Objectives: Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury.

Methods: We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose). We measured differences in peak creatine kinase-myocardial band (CK-MB) concentration, highly sensitive troponin T (hs-TnT), thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and corrected thrombolysis in myocardial infarction frame count (cTFC).

Results: The peak CK-MB level was comparable between the two groups (P = 0.327), but patients receiving high-dose NAC demonstrated a significantly larger reduction in hs-TnT (P = 0.02). In total, 94% of the NAC group achieved TIMI flow grade 3 versus 80% of the control group (P = 0.03). No significant differences were observed between the two groups in terms of changes in the cTFC and MBG.

Conclusions: In this study, NAC improved myocardial reperfusion markers and coronary blood flow, as revealed by differences in peak hs-TnT and TIMI flow grade 3 levels, respectively. Further studies with large samples are warranted to elucidate the role of NAC in this population. identifier: NCT01741207, and the Iranian Registry of Clinical Trials (IRCT; ) registration number: IRCT201301048698N8.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / administration & dosage*
  • Aged
  • Cardiotonic Agents / administration & dosage*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Humans
  • Infusions, Intravenous
  • Injections, Intra-Arterial
  • Iran / epidemiology
  • Male
  • Middle Aged
  • Myocardial Reperfusion Injury / diagnostic imaging
  • Myocardial Reperfusion Injury / prevention & control*
  • Percutaneous Coronary Intervention / adverse effects*
  • Percutaneous Coronary Intervention / trends
  • Prospective Studies
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / therapy*
  • Tertiary Care Centers* / trends


  • Cardiotonic Agents
  • Acetylcysteine

Associated data