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Vol. 44, No. 1, 2010
Issue release date: January 2010
Eur Surg Res 2010;44:30–36

Ischemia-Modified Albumin Reduction after Coronary Bypass Surgery Is Associated with the Cardioprotective Efficacy of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine: A Preliminary Study

Karahan S.C. · Koramaz İ. · Altun G. · Uçar U. · Topbaş M. · Menteşe A. · Kopuz M.
Departments of aBiochemistry, bCardiovascular Surgery and cPublic Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

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Background: The aims of this preliminary study were to determine the alteration of serum ischemia-modified albumin (IMA) levels and to investigate whether IMA may be used as an indicator of the cardioprotective efficacy of N-acetylcysteine (NAC) in patients undergoing coronary bypass grafting (CABG). Patients and Methods: Forty-four patients were randomized into one of two groups on the basis of cardioplegic strategies, either cold-blood cardioplegia enriched with NAC (50 mg/kg) or cold-blood cardioplegia alone. Serum IMA, cardiac troponin T (cTnT) and malondialdehyde (MDA) levels determined in NAC-enriched patients before and after CABG were compared with those of the NAC-free group. The albumin cobalt binding assay was used for IMA determination. Results: Serum IMA levels were significantly elevated after cross-clamping and peaked at 6 h after reperfusion in the two groups. In NAC-enriched patients, IMA levels determined 6, 12, 24 and 48 h after reperfusion were significantly lower than those of the NAC-free group (p ≤ 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IMA returned to baseline 24 h after reperfusion differently from cTnT and MDA in the NAC-enriched group. Conclusions: IMA may be used as not only an indicator of myocardial ischemia-reperfusion injury, but also as a useful indicator of the cardioprotective effect of NAC in CABG.

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  1. Elahi MM, Matata BM: Free radicals in blood: evolving concepts in the mechanism of ischemic heart disease. Arch Biochem Biophys 2006;450:77–88.

    External Resources

  2. Zweier JL, Talukder MAH: The role of oxidants and free radicals in reperfusion injury. Cardiovasc Res 2006;70:181–190.
  3. Dhalla NS, Elmoselhi AB, Hata T, Makino N: Status of myocardial antioxidants in ischemia-reperfusion injury. Cardiovasc Res 2000;47:446–456.
  4. Peacock F, Morris DL, Anwaruddin S, Christenson RH, Collinson PO, Goodacre SW, Januzzi JL, Jesse RL, Kaski JC, Kontos MC, Lefevre G, Mutrie D, Sinha MK, Uettwiller-Geiger D, Pollack CV: Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J 2006;152:253–262.
  5. Sinha MK, Roy D, Gaze DC, Collinson JC, Kaski PO: Role of ‘ischemia modified albumin’, a new biochemical marker of myocardial ischemia, in the early diagnosis of acute coronary syndromes. Emerg Med J 2004;21:29–34.
  6. Turedi S, Gunduz A, Mentese A, Karahan SC, Yilmaz SE, Eroglu O, Nuhoglu I, Turan I, Topbas M: Value of ischemia-modified albumin in the diagnosis of pulmonary embolism. Am J Emerg Med 2007;25:770–773.
  7. Gunduz A, Mentese A , Turedi S, Karahan SC, Mentese U, Eroglu O, Turkmen S, Turan I, Ucar U, Russell R, Balaban F: Serum ischemia-modified albumin increases in critical lower limb ischemia. Emerg Med J 2008;25:351–353.
  8. Gunduz A, Turedi S, Mentese A, Altunayoglu V, Turan I, Karahan SC, Topbas M, Aydin M, Eraydin I, Akcan B: Ischemia-modified albumin levels in cerebrovascular accidents. Am J Emerg Med 2008;26:874–878.
  9. Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC: Ischemia-modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation 2003;107:2403–2405.
  10. Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF: Role of reactive oxygen species on the formation of the novel diagnostic marker ischemia modified albumin. Heart 2006;92:113–114.
  11. Bar-Or D, Lau E, Winkler JV: A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia – a preliminary report. J Emerg Med 2000;19:311–315.
  12. Chambers DJ: Oxidative stress injury during cardiac surgery: how important is it? Cardiovasc Res 2007;73:626–628.
  13. Sochman J: N-acetylcysteine in acute cardiology: 10 years later, what do we know and what would we like to know? J Am Coll Cardiol 2002;39:1422–1428.
  14. Yesilbursa D, Serdar A, Senturk T, Serdar Z, Sağ S, Cordan J: Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction. Heart Vessels 2006;21:33–37.
  15. Koramaz I, Pulathan Z, Usta S, Karahan SC, Alver A, Yaris E, Kalyoncu NI, Ozcan F: Cardioprotective effect of cold-blood cardioplegia enriched with N-acetylcysteine during coronary artery bypass grafting. Ann Thorac Surg 2006;81:613–618.
  16. Yagi K: Lipid peroxides and related radicals in clinical medicine; in Armstrong D (ed): Free Radicals in Diagnostic Medicine. New York, Plenum Press, 1994, pp 1–15.
  17. Christenson RH, Duh SH, Sanhai WR, Wu AHB, Holtman V, Painter P, Branham E, Apple FS, Murakami M, Morris DL: Characteristics of an albumin cobalt binding test for assessment of acute coronary syndrome patients: a multicenter study. Clin Chem 2001;47:464–470.
  18. Fransen EJ, Maessen JG, Hermens WT, Glatz JFC, Burman WA: Peri-operative tissue injury and the release of inflammatory mediators in coronary artery bypass graft patients. Cardiovasc Res 2000;45:853–859.
  19. Dusec J, Stasek J, Tichy M, Bis J, Gregor J, Vojacek J, Masin V, Polansky P, Brtko M, Cernohorsky D: Prognostic significance of ischemia modified albumin after percutaneous coronary intervention. Clin Chim Acta 2006;367:77–80.
  20. Troxler M, Thompson D, Homer-Vanniasinkam S: Ischaemic skeletal muscle increases serum ischemia modified albumin. Eur J Endovasc Surg 2006;31:164–169.
  21. Bar-Or D, Winkler JV, Van Benthuysen K, Harris L, Lau E, Hetzel FW: Reduced albumin-cobalt binding with transient myocardial ischemia after elective percutaneous transluminal coronary angioplasty: a preliminary comparison to creatine kinase-MB, myoglobin, and troponin I. Am Heart J 2001;141:985–991.
  22. Drager LF, Andrade L, Barros de Toledo JF, Laurindo FRM, Cesar LAM, Seguro AC: Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injury. Nephrol Dial Transplant 2004;19:1803–1807.
  23. Cohen AS, Hadjinikolaou L, McColl A, Richmond W, Sapsford RA, Glenville BE: Lipid peroxidation, antioxidant status and troponin-T following cardiopulmonary bypass: a comparison between intermittent crossclamp with fibrillation and crystalloid cardioplegia. Eur J Cardiothorac Surg 1997;12:248–253.
  24. Tossios P, Bloch W, Huebner A, Raji MR, Dodos F, Klass O, Suedkamp M, Kasper SM, Hellmich M, Mehlhorn U: N-acetylcysteine prevents reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery: results of a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg 2003;126:1513–1520.
  25. Sucu N, Cinel I, Unlu A, Aytacoglu B, Tamer L, Kocak Z, Karaca K, Gul A, Dikmengil M, Atik U, Oral U: N-acetylcysteine for preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass. Surg Today 2004;34:237–242.
  26. 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;37:349–355.
  27. Baker WL, Anglade MW, Baker EL, White CM, Kluger J, Coleman CI: Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: a meta-analysis. Eur J Cardiothorac Surg 2009;35:521–527.
  28. El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, Carteier R, Page P, Perrault LP: Effect of intravenous N-acetylcysteine outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg 2007;133:7–12.
  29. Bapat V, Allen D, Young C, Roxburgh J, Ibrahim M: Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg 2005;20:212–217.

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