(Circulation. 1995;92:2855-2862.)
© 1995 American Heart Association, Inc.
Articles |
N-Acetylcysteine in Combination With Nitroglycerin and Streptokinase for the Treatment of Evolving Acute Myocardial Infarction
Safety and Biochemical Effects
From the Cardiology Unit (M.A.A., J.Y., I.S., J.D.H.) and the Rheumatology Unit (W.H.B.), The Queen Elizabeth Hospital, University of Adelaide, South Australia, Australia.
Correspondence to Prof J.D. Horowitz, Senior Director, Cardiology Unit, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville South, South Australia 5011, Australia.
Background N-acetylcysteine (NAC) has been shown to potentiate the effects of nitroglycerin (NTG) and to have antioxidant activity. This is the first study to assess the safety and effect of NAC in the treatment of evolving acute myocardial infarction (AMI).
Methods and Results Patients with AMI received either 15 g NAC infused over 24 hours (n=20) or no NAC (n=7), combined with intravenous NTG and streptokinase. Peripheral venous plasma malondialdehyde (MDA), reduced (GSH) and oxidized (GSSG) glutathione concentrations, and rate of reperfusion (using continuous ST-segment analysis) were measured. Cardiac catheterization was performed between days 2 and 5. No significant adverse events occurred. Less oxidative stress occurred in patients treated with NAC than in patients not receiving NAC (GSH to GSSG ratio 44±25 versus 19±13 at 4 hours, P<.05). NAC concentration (mean 172±79 µmol/L at 4 hours) was correlated to GSH concentration (P=.006). MDA concentrations were lower (P=.001) over the first 8 hours of treatment with NAC. There was a trend toward more rapid reperfusion (median 58 minutes, 95% confidence interval [CI] 48 to 98 minutes versus median 95 minutes, 95% CI 59 to 106 minutes; P=.17) and better preservation of left ventricular function (cardiac index 3.4±0.8 versus 2.6±0.27 L · min · m2, P=.009) with NAC treatment.
Conclusions NAC in combination with NTG and streptokinase appeared to be safe for the treatment of evolving AMI and was associated with significantly less oxidative stress, a trend toward more rapid reperfusion, and better preservation of left ventricular function.
Key Words: free radicals • reperfusion • myocardial infarction
This article has been cited by other articles:
 |
|
 |
|
  J. R. Brown, C. A. Block, D. J. Malenka, G. T. O'Connor, A. C. Schoolwerth, and C. A. Thompson Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis: A Meta-Analysis J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1116 - 1124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Meyer, M. M. LeWinter, S. P. Bell, Z. Chen, D. E. Selby, D. K. Singla, and H. L. Dauerman N-Acetylcysteine-Enhanced Contrast Provides Cardiorenal Protection J. Am. Coll. Cardiol. Intv., March 1, 2009; 2(3): 215 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Gustafsson and R. A. Gottlieb Heart mitochondria: gates of life and death Cardiovasc Res, January 15, 2008; 77(2): 334 - 343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rudnick and H. Feldman Contrast-Induced Nephropathy: What Are the True Clinical Consequences? Clin. J. Am. Soc. Nephrol., January 1, 2008; 3(1): 263 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. W.A. Verheugt Response to Letter Regarding Article, "Reperfusion Starts in the Ambulance" Circulation, December 12, 2006; 114(24): e641 - e641. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Marenzi, E. Assanelli, I. Marana, G. Lauri, J. Campodonico, M. Grazi, M. De Metrio, S. Galli, F. Fabbiocchi, P. Montorsi, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N. Engl. J. Med., June 29, 2006; 354(26): 2773 - 2782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Pannu, N. Wiebe, M. Tonelli, and for the Alberta Kidney Disease Network Prophylaxis Strategies for Contrast-Induced Nephropathy JAMA, June 21, 2006; 295(23): 2765 - 2779. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Kevin, E. Novalija, and D. F. Stowe Reactive Oxygen Species as Mediators of Cardiac Injury and Protection: The Relevance to Anesthesia Practice Anesth. Analg., November 1, 2005; 101(5): 1275 - 1287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Gleeson and S. Bulugahapitiya Contrast-Induced Nephropathy Am. J. Roentgenol., December 1, 2004; 183(6): 1673 - 1689. [Full Text] [PDF]
|
|
|
|
 |
|
 L. F. Drager, L. Andrade, J. F. Barros de Toledo, F. R. M. Laurindo, L. A. Machado Cesar, and A. C. Seguro Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injury Nephrol. Dial. Transplant., July 1, 2004; 19(7): 1803 - 1807. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. M. Fischer, C. S. Cox Jr, S. J. Allen, R. H. Stewart, U. Mehlhorn, and G. A. Laine The antioxidant N-acetylcysteine preserves myocardial function and diminishes oxidative stress after cardioplegic arrest J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1483 - 1488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kay, W. H. Chow, T. M. Chan, S. K. Lo, O. H. Kwok, A. Yip, K. Fan, C. H. Lee, and W. F. Lam Acetylcysteine for Prevention of Acute Deterioration of Renal Function Following Elective Coronary Angiography and Intervention: A Randomized Controlled Trial JAMA, February 5, 2003; 289(5): 553 - 558. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.-G. i Shyu, J.-J. Cheng, and P. Kuan Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure J. Am. Coll. Cardiol., October 16, 2002; 40(8): 1383 - 1388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sochman N-acetylcysteine in acute cardiology: 10 years later: What do we know and what would we like to know?! J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1422 - 1428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Safirstein, L. Andrade, and J. M. Vieira Acetylcysteine and Nephrotoxic Effects of Radiographic Contrast Agents -- A New Use for an Old Drug N. Engl. J. Med., July 20, 2000; 343(3): 210 - 212. [Full Text]
|
|
|
|
 |
|
 Z. Ungvari, P. Pacher, K. Rischak, L. Szollar, and A. Koller Dysfunction of Nitric Oxide Mediation in Isolated Rat Arterioles With Methionine Diet–Induced Hyperhomocysteinemia Arterioscler Thromb Vasc Biol, August 1, 1999; 19(8): 1899 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Reilly, N. Delanty, L. Roy, J. Rokach, P. O. Callaghan, P. Crean, J. A. Lawson, and G. A. FitzGerald Increased Formation of the Isoprostanes IPF2{alpha}-I and 8-Epi-Prostaglandin F2{alpha} in Acute Coronary Angioplasty : Evidence for Oxidant Stress During Coronary Reperfusion in Humans Circulation, November 18, 1997; 96(10): 3314 - 3320. [Abstract] [Full Text]
|
|