Efficacy Of Electroacupuncture Pretreatment For Myocardial Injury In Patients Undergoing Percutaneous Coronary Intervention

In cardiovascular disease, coronary atherosclerotic heart disease is a kind of illness with severe symptoms and critical complications, which is a serious threat to human life and health. Currently,the percutaneous coronary stenting is one of the main treatment to solve the myocardial ischemia quickly. The timely implementation of cardiovascular intervention can save the damaged myocardium and effectively reduce the mortality of patients. However, it can also lead to the corresponding myocardial ischemia- reperfusion injury while IRI can increase the degree of myocardial injury, and even lead to death. As a result, searching a way to improve tolerance of myocardial ischemia has been very important clinical research value in improving the prevention of IRI and the prognosis after PCI.Acupuncture is a traditional Chinese medical treatment. In recent years, based on the traditional acupuncture, electro-acupuncture developed gradually. It combined with electronic technic and clinical practice. EA has the similar function to traditional acupuncture. The Electro-acupuncture Pretreatment mainly concentrated in the study of neural protection. A large number of animal had been experimented and confirmed that ischemia electrical pretreatment can induce ischemic tolerance. We found that EA pretreatment can not only improve the heat shock protein 70(Heat proteins, HSP 70) levels, and improve cerebral ischemic tolerance, but also can promote brain encephalin release, reduce matrix metalloproteinase-9 expression, and weaken brain ischemia reperfusion injury. Recent studies have found that EA pretreatment significantly reduces infarct volume and improve neurological function. In addition, EA pretreatment can be selective cannabinoid CB1 receptor antagonist AM251 and CB1 siRNA inhibition. It suggested that EA pretreatment could increase endogenous brain organization of cannabinoid(2-AG and AEA) release. It also regulated kinase activation by endangering cannabinoids outside cells which play a protective role in the brain tissue. In addition to the brain protection effect, electro-acupuncture preconditioning on myocardial protection has been paid more and more attention. EA pretreatment confirmed in animal experiments by changing the levels of inflammatory factors, lower CK content, lower troponin levels and producing a protective effect on the heart. Yang Lifang and Ni Xinli, the two main clinical researchers, confirmed that EA pretreatment can reduce the adult and pediatric open heart operation of myocardial ischemia / reperfusion injury. These results suggest that EA pretreatment on myocardial ischemia / reperfusion injury has a protective effect. However, there are no relevant effects of EA pretreatment on the PCI operation in the report. This study tries to reduce the injury of ischemia reperfusion and improve the prognosis by clinical studies in patients with EA pretreatment. It also provides new evidence for the clinical treatment of disease prevention. ObjectiveThe main purpose of this study is to evaluate the effect of reducing cTnI levels with EA pretreatment 1-2h in prior to PCI surgery. The symptoms of myocardial ischemia due to occlusion of coronary based on ultrasound image changes, heartbeat ischemic ECG changes, CRP, major adverse reactions of cardiac and cerebrovascular events were influenced during long term EA after operation. Results were obtained in the third month and the sixth months post operation.To explore the mechanism of EA on myocardial protection by examinanting the level of inflammatory bio marker-cytokines in vivo(HMGB1/TNF-a/IL-6/IL-10/CRP/NOS/NO). Methods204 patients from different hospital in different orgions were randomly assigned into experiment group(EA group) and control group(Con group). 102 objects(male 67, female 35) were assigned to EA group and the average age of these patients was 60.69±9.7 years old. While Con group consists the equal amount of objects(male 81, female 21) and the average age of these patients was 59.07±9.4 years old. 1h before operative, the objects in EA group were given EA pretreatment. Acupoint were bilateral Neiguan and Ximen points, with electrode sliced on the points. Electrodes were connected to Huatuo electronic therapy device(V-type). Selected density wave(wave sparse 2Hz, dense wave 30Hz) and suitable current betwent 3 ~ 6mA were used for 30 min. The control group was not given any stimulation from the therapy device while the other conditions remain the same to EA group.Measured the preoperative and postoperative troponin I(cTnI) content with inflammation-related factors(HMGB1/ TNF-α /IL-6/IL-10/CRP/NOS/NO) levels before and 24 h after PCI, observe the change of ECG after 24 h, 72 h, 3 months and 6 months after PCI. Compare the PET/CT results obtained in each interval and examine the difference between the standard uptake value, after 3 months and 6 months. ECG graphs were used to measure patients with any left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDD), left ventricular end diastolic volume(EDV) and stroke volume(SV). Results from echocardiography, cardiac hemodynamics were also compared. All patients were regularly followed-up after 24 months post-surgery to prevent any major adverse cardiac and cerebrovascular events(MACCE). ResultsThe level of cTn I in EA group has no significant difference(P=0.496). In 24 hours after operation, there were 51 patients in Con group whose cTnI concentration were higher than 0.2ng/ml, which were higher than average in EA group(P=0.04). It shows less MI(MI4a) incidence rate in electro-acupuncture stimulation group. According to the Duke risk score, the difference in patients with coronary artery disease is smaller(P=0.793). The Duke score was significantly reduced in the group of complexity of coronary artery lesion(P=0.02). 24 hours after PCI, the level of TNF-α(P=0.021)、IL-6(P=0.010)in patients is significantly reduced in EA group, while the level of IL-10 increased significantly(P=0.004). Echocardiographic analysis shows the LVEF in EA group has significant difference compared to the control group(P=0.032) from the result of 3rd month. And the cardiac hemodynamics of patients in EA group was significantly improved after 6 months. The level of LVEF(P=0.012)、LVEDD(P=0.014)、EDV(P=0.045)、SV(P=0.017) has few differences compare with the control group(P=0.012, 0.014, 0.045, 0.017). The PET/CT results show that the electro-acupuncture pretreatment can improve the ability of myocardial ischemia tolerance in PCI surgery patients and may also reduce inflammation after myocardial injury. The patients were followed up for 24 months, the incidents of MACCE in patients of EA group has significiant difference(F=5.83, P=0.0157) to control group, which means that the electro-acupuncture pretreatment has a positive effect on prevention of MACCE. ConclusionEA pretreatment before PCI can significantly decreases the cTn I level in patients with ST segment changes. Also it reduces arrhythmia, stroke and any other cardiovascular adverse events. It can promote the recovery of cardiac hemodynamics, further reduces myocardial ischemia reperfusion in myocardial injury. EA pretreatment plays an important role in the protection of cardiac function and improve the prognosis of PCI.