Abstract 4371906: Targeting Oxidative Stress Before Cardiac Surgery: A Systematic Review and Meta Analysis of 65 RCTs focusing on Cardiorenal Protection from Antioxidant Supplementation

Abstract

Background: Cardiac surgery remains associated with a high incidence of cardiac and renal complications, mainly due to oxidative stress. This provides a rationale for evaluating antioxidant therapy as a preventive strategy. Despite advances in perioperative care improving outcomes and lowering mortality, the role of nutritional interventions—particularly antioxidants—remains under investigation. Methods: We conducted a systematic search across PubMed, Embase, Scopus, and Web of Science databases (1990-2025) We included randomized controlled trials (RCTs) that evaluated antioxidant supplementation, ascorbic acid (Vitamin C), polyunsaturated fatty acids (PUFAs), or N-acetylcysteine (NAC) in comparison to placebo among patients undergoing any form of cardiac surgery. Primary outcomes assessed were postoperative atrial fibrillation (POAF), acute kidney injury (AKI), all-cause mortality, and the need for renal replacement therapy (RRT) .A meta-analysis was conducted using a random-effects model to estimate pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 65 studies encompassing 12,259 patients were included. N-acetylcysteine administration was associated with a statistically significant reduction in the incidence of postoperative atrial fibrillation (OR 0.47; 95% CI: 0.32–0.71; p = 0.0002); it did not result in a substantial reduction in the incidence of postoperative acute kidney injury (OR 0.81; 95% CI: 0.63–1.06; p = 0.12), postoperative mortality (OR 0.69; 95% CI: 0.38–1.25; p = 0.22), or need for renal replacement therapy (OR 1.11; 95% CI: 0.58–2.13; p = 0.76). Vitamin C supplementation significantly reduced the incidence of postoperative atrial fibrillation (OR 0.46; 95% CI: 0.28–0.78; p = 0.004) and postoperative mortality (OR 0.20; 95% CI: 0.05–0.75; p = 0.02);, it showed no change in the incidence of acute kidney injury (OR 0.63; 95% CI: 0.27–1.49; p = 0.30). Supplementation with polyunsaturated fatty acids was associated with a reduction in the incidence of postoperative atrial fibrillation (OR 0.70; 95% CI: 0.54–0.92; p = 0.009); however, it did not reduce the incidence of postoperative acute kidney injury (OR 1.11; 95% CI: 0.51–2.41; p = 0.80) or postoperative mortality (OR 0.61; 95% CI: 0.32–1.16; p = 0.13). Conclusion: Antioxidant therapies, particularly N-acetylcysteine and vitamin C, significantly reduce POAF after cardiac surgery, underscoring oxidative stress as a key therapeutic target.