Protective Effects of N-Acetyl Cysteine on Cardiac Function in Diabetic Patients Undergoing Coronary Artery Bypass Grafting

Document Type : Original Article


1 Hamadan University of Medical Sciences, Hamadan, IR Iran.

2 Department of Anesthesia, Khatam-ol-Anbia Hospital of Miane, Tabriz University of Medical Sciences, Tabriz, IR Iran.

3 Department of Biostatics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, IR Iran.


Background: The preservation of cardiac function in diabetic patients undergoing coronary artery bypass grafting (CABG) would result in improved prognoses in patients. Therefore, in this study, the protective effects of N-acetyl cysteine (NAC) on cardiac function in diabetic patients undergoing CABG were determined.
Methods: This triple-blind, randomized, clinical trial study recruited 240 consecutive diabetic patients undergoing CABG in a referral tertiary health-care center, Hamadan, Iran. The patients were randomly assigned (simple random sampling) to receive either NAC or a placebo. In both groups, ischemic preconditioning was developed with a manometer cuff around the arm. The cuff was filled up to 200 mm Hg for 5 minutes before it was emptied to 0 mm Hg for 5 minutes. This technique was repeated 3 times.
Results: The mean preoperative ejection fraction (EF) and the preoperative myocardial performance index (MPI) were the same in the 2 groups (P>0.05). The postoperative EF and the MPI were not significantly different between the 2 groups (P>0.05). The trend of changes in the EF and the MPI was not different between the groups (P>0.05).
Conclusions: This study demonstrated that NAC in the ischemic preconditioning method did not create a significant effect compared with a placebo, which is in congruence with previous studies in animal models. (Iranian Heart Journal 2021; 22(2): 96-100)


  1. Shi A, Tao Z, Wei P, Zhao J. Epidemiological aspects of heart diseases. Exp Ther Med. 2016; 12(3):1645–50.
  2. Hinton W, McGovern A, Coyle R, Han TS, Sharma P, Correa A, et al. Incidence and prevalence of cardiovascular disease in English primary care: a cross-sectional and follow-up study of the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). BMJ Open 2018; 8(8):e020282.
  3. Cassar A, Holmes DRJ, Rihal CS, J. GB. Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009; 84(12):1130-46.
  4. Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA, et al. Coronary-artery bypass surgery in patients with Ischemic cardiomyopathy. N Engl J Med. 2016; 374(16):1511-20.
  5. Montrief T, Koyfman A, Long B. Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med. 2018; 36(12):2289-97.
  6. Harris R, Croce B, Tian DH. Coronary artery bypass grafting. Ann Cardiothorac Surg. 2013; 2(4):579.
  7. Safaie N, Montazerghaem H, Jodati A, Maghamipour N. In-hospital complications of coronary artery bypass graft surgery in patients older than 70 years. J Cardiovasc Thorac Res. 2015; 7(2):60-2.
  8. Diodato M, Chedrawy EG. Coronary artery bypass graft surgery: the past, present, and future of myocardial revascularisation. Surg Res Pract. 2014; 2014:726158.
  9. Jahangiry L, Najafi M, Farhangi MA, Jafarabadi MA. Coronary artery bypass graft surgery outcomes following 6.5 years: A nested case-control study. Int J Prev Med. 2017;8:23.
  10. Candilio L, Hausenloy D. Is there a role for ischaemic conditioning in cardiac surgery? F1000Res. 2017;6:563.
  11. Hausenloy DJ, Boston-Griffiths E, Yellon DM. Cardioprotection during cardiac surgery. Cardiovasc Res. 2012; 94(2):253-65.
  12. Li H, Yao W, Liu Z, Xu A, Huang Y, Ma XL, et al. Hyperglycemia abrogates ischemic postconditioning cardioprotection by impairing adipoR1/caveolin-3/STAT3 signaling in diabetic rats. Diabetes. 2016; 65(4):942-55.
  13. Raza S, Sabik JF, Ainkaran P, Blackstone EH. Coronary artery bypass grafting in diabetics: A growing health care cost crisis. J Thorac Cardiovasc Surg. 2015; 150(2):304–2.e2.
  14. Su W, Zhang Y, Zhang Q, Xu J, Zhan L, Zhu Q, et al. N-acetylcysteine attenuates myocardial dysfunction and postischemic injury by restoring caveolin-3/eNOS signaling in diabetic rats. Cardiovasc Diabetol. 2016; 15:146.
  15. Liu XH, Xu CY, Fan GH. Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials. BMC Cardiovasc Disord. 2014; 14(1):52.
  16. Eren N, Cakir O, Oruc A, Kaya Z, Erdinc L. Effects of N-acetylcysteine on pulmonary function in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Perfusion J. 2003; 18(6):345-50.
  17. Vento AE, Nemlander A, Aittomäki J, Salo J, Karhunen J, Rämö OJ. N-acetylcysteine as an additive to crystalloid cardioplegia increased oxidative stress capacity in CABG patients. Scand Cardiovasc J. 2003; 37(6):349-55.
  18. Sucu N, Cinel I, Unlu A, Aytacoglu B, Tamer L, Kocak Z, et al. N-acetylcysteine for preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass. Surg Today. 2004; 34(3):237-42.
  19. Orhan G, Yapici N, Yuksel M, Sargin M, Şenay Ş, Yalçin AS, et al. Effects of N-acetylcysteine on myocardial ischemia–reperfusion injury in bypass surgery. Heart Vessels 2006; 21:42-7.
  20. El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, et al. Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg. 2007; 133(1):7-12.
  21. Peker O, Peker T, Erdogan D, Ozaydin M, Kapan S, Sutcu R, et al. Effects of intravenous N-acetylcysteine on periprocedural myocardial injury after on-pump coronary artery by-pass grafting. J Cardiovasc Surg. 2008; 49(4):527-31.
  22. Kurian GA, Paddikkala J. N-acetylcysteine and magnesium improve biochemical abnormalities associated with myocardial ischaemic reperfusion in South Indian patients undergoing coronary artery bypass grafting: a comparative analysis. Singapore Med J. 2010; 51(5):381-8.