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Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials.

Liu XH, Xu CY, Fan GH - BMC Cardiovasc Disord (2014)

Bottom Line: Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital.No difference in the incidence of cerebrovascular events was observed.However, larger RCTs evaluating these and other postoperative complication endpoints are needed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Wuhan General Hospital of Guangzhou Military Command, 627 Wuluo Road, Wuhan, China. fanguanghui59@163.com.

ABSTRACT

Background: Atrial fibrillation is a common complication after cardiac surgery. The aim of this study is to evaluate whether N-acetylcysteine (NAC) could prevent postoperative atrial fibrillation (POAF).

Methods: PubMed, Embase and Cochrane Center Register of Controlled Trials were searched from the date of their inception to 1 July 2013 for relevant randomized controlled trials (RCTs), in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF, all-cause mortality, length of intensive care unit (ICU) stay, hospital length of stay, and the incidence of cerebrovascular events. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.

Results: We retrieved ten studies enrolling a total of 1026 patients. Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital. No difference in the incidence of cerebrovascular events was observed.

Conclusions: Prophylactic use of NAC could reduce the incidence of POAF and all-cause mortality in adult patients undergoing cardiac surgery. However, larger RCTs evaluating these and other postoperative complication endpoints are needed.

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Related in: MedlinePlus

Effects of short-term N-acetylcysteine administration on the prevention of postoperative atrial fibrillation.
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Figure 4: Effects of short-term N-acetylcysteine administration on the prevention of postoperative atrial fibrillation.

Mentions: Sensitivity analyses were conducted to test the robustness of the main analysis. We tested whether excluding small sample studies (n <60 patients) [19,20,22,26] would change the direction of the overall result. The meta-analysis of the remaining studies (OR 0.57, 95% CI 0.40 to 0.80; P = 0.001) [12,16,21,23-25] was similar to the overall result, with little statistical heterogeneity (I2 = 42%, P = 0.12). A trial [25] enrolled some patients with a history of AF, but the pooled results (OR 0.50; 95% CI 0.35 to 0.71; P < 0.001; I2 = 0%, Pheterogeneity = 0.56) did not change when this trial was exclude. In addition, we tested whether different duration of NAC supplementation after cardiac surgery would alter the direction of the overall result. Using the fixed-effects model, the meta-analysis of studies (OR 0.40; 95% CI 0.25 to 0.65; P < 0.001; I2 = 22%, Pheterogeneity =0.28; Figure 3) [12,16,21,22] with a long-term (lasting for 48 h-72 h after operation) was similar to the overall effects (OR 0.56, 95% CI 0.40 to 0.77). However, it failed to reduce the incidence of POAF with a short-term NAC (within 24 h after surgery) supplementation (OR 0.64; 95% CI 0.39 to 1.06; P = 0.09; I2 = 0%, Pheterogeneity =0.7; Figure 4) [19,23-26].


Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials.

Liu XH, Xu CY, Fan GH - BMC Cardiovasc Disord (2014)

Effects of short-term N-acetylcysteine administration on the prevention of postoperative atrial fibrillation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4012554&req=5

Figure 4: Effects of short-term N-acetylcysteine administration on the prevention of postoperative atrial fibrillation.
Mentions: Sensitivity analyses were conducted to test the robustness of the main analysis. We tested whether excluding small sample studies (n <60 patients) [19,20,22,26] would change the direction of the overall result. The meta-analysis of the remaining studies (OR 0.57, 95% CI 0.40 to 0.80; P = 0.001) [12,16,21,23-25] was similar to the overall result, with little statistical heterogeneity (I2 = 42%, P = 0.12). A trial [25] enrolled some patients with a history of AF, but the pooled results (OR 0.50; 95% CI 0.35 to 0.71; P < 0.001; I2 = 0%, Pheterogeneity = 0.56) did not change when this trial was exclude. In addition, we tested whether different duration of NAC supplementation after cardiac surgery would alter the direction of the overall result. Using the fixed-effects model, the meta-analysis of studies (OR 0.40; 95% CI 0.25 to 0.65; P < 0.001; I2 = 22%, Pheterogeneity =0.28; Figure 3) [12,16,21,22] with a long-term (lasting for 48 h-72 h after operation) was similar to the overall effects (OR 0.56, 95% CI 0.40 to 0.77). However, it failed to reduce the incidence of POAF with a short-term NAC (within 24 h after surgery) supplementation (OR 0.64; 95% CI 0.39 to 1.06; P = 0.09; I2 = 0%, Pheterogeneity =0.7; Figure 4) [19,23-26].

Bottom Line: Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital.No difference in the incidence of cerebrovascular events was observed.However, larger RCTs evaluating these and other postoperative complication endpoints are needed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Wuhan General Hospital of Guangzhou Military Command, 627 Wuluo Road, Wuhan, China. fanguanghui59@163.com.

ABSTRACT

Background: Atrial fibrillation is a common complication after cardiac surgery. The aim of this study is to evaluate whether N-acetylcysteine (NAC) could prevent postoperative atrial fibrillation (POAF).

Methods: PubMed, Embase and Cochrane Center Register of Controlled Trials were searched from the date of their inception to 1 July 2013 for relevant randomized controlled trials (RCTs), in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF, all-cause mortality, length of intensive care unit (ICU) stay, hospital length of stay, and the incidence of cerebrovascular events. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.

Results: We retrieved ten studies enrolling a total of 1026 patients. Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital. No difference in the incidence of cerebrovascular events was observed.

Conclusions: Prophylactic use of NAC could reduce the incidence of POAF and all-cause mortality in adult patients undergoing cardiac surgery. However, larger RCTs evaluating these and other postoperative complication endpoints are needed.

Show MeSH
Related in: MedlinePlus