Effects of perioperative MESNA on lipid peroxidation and myocardial injury in patients undergoing coronary artery bypass grafting: a randomized, double-blind, placebo-controlled trial.

Oxidative stress is a major contributor to myocardial injury following coronary artery bypass grafting (CABG). MESNA (sodium 2-mercaptoethane sulfonate), a thiol-containing antioxidant, has demonstrated potent free radical scavenging properties. This study evaluated the effects of perioperative MESNA administration on oxidative stress, myocardial injury biomarkers, and early postoperative cardiac function in patients undergoing elective on-pump CABG. In this randomized, double-blind, placebo-controlled trial, 100 adults undergoing elective isolated CABG with cardiopulmonary bypass were randomly assigned (1:1) to receive intravenous MESNA (1600 mg) or placebo. The primary outcome was postoperative oxidative stress assessed by serum malondialdehyde (MDA). Secondary outcomes included cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), and left ventricular ejection fraction (LVEF). Baseline MDA concentrations were comparable between groups. MESNA significantly reduced postoperative MDA concentrations over the first 24 h compared with placebo (group-by-time interaction, P < 0.001). CK-MB concentrations were significantly lower in the MESNA group, with an estimated between-group difference of - 22.42 U/L at 24 h (P = 0.001). In contrast, cTnI concentrations did not differ significantly between groups. Patients receiving MESNA had higher LVEF at hospital discharge, and this association remained significant after multivariable adjustment (adjusted β = 2.93, 95% CI 0.98-4.87; P = 0.004). No treatment-related adverse events were observed. In patients undergoing elective on-pump CABG, perioperative administration of MESNA was associated with reduced postoperative lipid peroxidation, lower CK-MB release, and improved early postoperative ventricular function. Larger multicenter studies are needed to confirm these findings and their clinical significance.