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Effects of N-Acetylcysteine on the Cardiac Remodeling Biomarkers and Major Adverse Events Following Acute Myocardial Infarction: A Randomized Clinical Trial

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Abstract

Aims

The aims of this study were to evaluate the effects of N-acetylcysteine (NAC) on cardiac remodeling and major adverse events following acute myocardial infarction (AMI).

Methods

In a prospective, double-blind, randomized clinical trial, the effect of NAC on the serum levels of cardiac biomarkers was compared with that of placebo in 98 patients with AMI. Also, the patients were followed up for a 1-year period for major adverse cardiac events (MACE), including the occurrence of recurrent myocardial infarction, death, and need for target vessel revascularization.

Results

In patients who received NAC, the serum levels of matrix metalloproteinase (MMP)-9 and MMP-2 after 72 h were significantly lower than those in the placebo group (p = 0.014 and p = 0.045, respectively). The length of hospitalization in patients who received NAC was significantly shorter than that in the placebo group (p = 0.024). With respect to MACE, there was a significant difference between those who received NAC (14 %) and those patients on placebo (25 %) (p = 0.024). Re-infarction took place in 4 % of patients in the NAC group as compared with 16.7 % in patients who received placebo (p = 0.007).

Conclusion

NAC can be beneficial in preventing early remodeling by reducing the level of MMP-2 and MMP-9. Moreover, NAC decreased the length of hospital stays in patients after AMI. By decreasing MACE, NAC could possibly be introduced as a ‘magic bullet’ in the pharmacotherapy of patients with AMI. Further studies are needed to elucidate NAC’s role in this population.

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Acknowledgments

This study was supported by a grant from the Office of the Vice-Chancellor for Research of the Tehran University of Medical Sciences. The authors appreciate Tehran Heart Center nursing, laboratory, and emergency department staff for their valuable participation in this work. We also would like to thank Dr. Jamshid Salamzadeh for his kind support.

Conflicts of interest

The authors have no conflicts of interest regarding this work.

Funding

The authors have not received any financial support regarding this research.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, P.O.Box 14155/6451, 1417614411, Tehran, Iran

    Azita Hajhossein Talasaz & Hossein Khalili

  2. Department of Clinical Pharmacy, Faculty of Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

    Fanak Fahimi

  3. Emergency Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Yaser Jenab

  4. Department of Molecular Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Ali Broumand

  5. Interventional Cardiologist, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Mojtaba Salarifar

  6. Resident of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Farzad Darabi

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  1. Azita Hajhossein Talasaz
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  2. Hossein Khalili
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Correspondence to Hossein Khalili.

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Talasaz, A.H., Khalili, H., Fahimi, F. et al. Effects of N-Acetylcysteine on the Cardiac Remodeling Biomarkers and Major Adverse Events Following Acute Myocardial Infarction: A Randomized Clinical Trial. Am J Cardiovasc Drugs 14, 51–61 (2014). https://doi.org/10.1007/s40256-013-0048-x

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