inflammation, oxidative stress, and fibrosis play important roles after an acute myocardial infarction (AMI) event. The most studied inflammatory biomarker in cardiovascular disease is C-reactive protein (CRP). It has been demonstrated that myeloperoxidase (MPO) and Galectin-3 (Gal-3) have some essential roles on immune system when an AMI event occurs. We aimed to determine the effect of oral N-acetylcysteine (NAC) supplementation at the dose of 600 mg 3 times daily for 3 consecutive days on the immune system of AMI patients.
Methods: our randomized single-blinded experimental study using pre- and post-treatment evaluations was performed at Dr. Moewardi Hospital, Indonesia, from May to August 2018. Thirty-two patients with AMI and ST segment elevation (STEMI) who received fibrinolytic therapy were included. There were 17 patients received standard therapy plus 600 mg oral NAC supplementation every 8 h for 3 days and 15 patients received standard therapy, which served as the control group. High-sensitivity C-reactive protein (HsCRP), MPO, and Gal-3 levels of both groups were evaluated at admission and after 72 h receiving treatment. Results: HsCRP, MPO, and Gal-3 levels between NAC and control groups at admission were not significantly different; while intergroup differences after 72 h of NAC supplementation were significant (p values of HsCRP, MPO, and Gal-3 levels were 0.0001, 0.001, and 0.017, respectively). Furthermore, in the NAC group, HsCRP, MPO, and Gal-3 levels at 72 h after treatment were significantly different from the corresponding levels at admission (p values: 0.0001, 0.0001, and 0.0001, respectively); the control group did not show these differences. There were also significant intergroup differences between the NAC and control groups regarding HsCRP, MPO, and Gal-3 levels (p values: 0.011, 0.022, and 0.014, respectively).
Conclusion: oral supplementation of 600 mg NAC every 8 h for 72 h can reduce HsCRP, MPO, and Gal-3 levels in AMI patients receiving fibrinolytic therapy. Results of our study will provide more options for supplementation therapy to improve management of IMA patients.
atar belakang: inflamasi, stres oksidatif dan fibrosis memegang peran penting setelah terjadinya infark miokard akut (IMA). Biomarker inflamasi yang banyak dipelajari pada penyakit kardiovaskular adalah C-reactive protein. Ada bukti bahwa myeloperoksidase (MPO) dan galectin-3 (Gal-3) memegang peran penting pada sistem imun tubuh saat terjadi IMA. Penelitian ini bertujuan untuk melihat efek pemberian terapi tambahan N-acetylcystein (NAC) secara oral 600 mg 3 kali sehari selama 3 hari terhadap sistem imun pasien IMA. Metode: penelitian eksperimental acak, tersamar tunggal dengan metoda pre- dan post-test. Dilakukan di Rumah Sakit Dr. Moewardi Surakarta, dari bulan Mei hingga Agustus 2018. Tiga puluh dua pasien IMA dengan elevasi segmen ST (STEMI) yang mendapat terapi fibrinolitik masuk penelitian: 17 pasien mendapat terapi standar ditambah NAC 600 mg per oral setiap 8 jam selama 3 hari dan 15 pasien mendapat terapi standar sebagai kontrol. Kadar high sensitivity C-reaktif protein (HsCRP), MPO, dan Galectin-3 dari kedua kelompok diperiksa saat masuk dan setelah 72 jam perawatan. Hasil: kadar HsCRP, MPO, dan Gal-3 pada kelompok NAC dan kontrol pada saat admisi tidak berbeda bermakna, sedangkan kadar antar kelompok pasca 72 jam pemberian NAC didapatkan perbedaan yang bermakna dengan nilai p untuk kadar HsCRP, MPO, dan Gal-3 sebesar 0,0001, 0,001, dan 0,017. Pada kelompok NAC saat admisi dan pasca 72 jam, didapatkan perbedaan kadar HsCRP, MPO, dan Gal-3 yang bermakna dengan nilai p secara berurutan 0,0001, 0,0001 dan 0,0001; sedangkan pada kelompok kontrol tidak didapatkan perbedaan ini. Terdapat perbedaan kadar HsCRP, MPO, dan Gal-3 yang bermakna antara kelompok NAC dan kelompok kontrol (nilai p secara berurutan adalah 0,011, 0,022 dan 0,014). Kesimpulan: pemberian terapi tambahan NAC 600 mg oral tiap 8 jam selama 72 jam dapat menurunkan kadar HsCRP, MPO, dan Gal-3 pada pasien IMA yang mendapatkan terapi fibrinolitik. Hasil penelitian ini akan memberikan pilihan terapi tambahan untuk pengelolaan pasien IMA yang lebih baik
