| ObjectiveBy observing the clinical effect of levosimendan immediately after PCI in patients with acute myocardial infarction,the effectiveness and safety of early application of levosimendan after PCI in acute myocardial infarction were evaluated.Method120 patients with AMI admitted to the Second Hospital of Shanxi Medical University from October 2017 to October 2019 were selected as the research objects.Among them,there were 77 males and 43 females,aged 56-74 years,with an average age of 64.32±3.9.The patients were assigned to 60 cases in the levosimendan group(conventional treatment of AMI+ levosimendan)or 60 cases in the control group(conventional treatment of AMI).All patients were diagnosed as first-episode AMI according to the Guidelines for the Diagnosis and Treatment of Acute Myocardial Infarction and the results of coronary angiography.And all PCI operations were completed within 24 hours after the patients developed chest pain.The levosimendan group was given levosimendan immediately after PCI.The initial infusion rate was 0.1ug/kg/min.If tolerable 1 hour after the infusion,it was increased to 0.2ug/kg/min for 23 hours.All patients were given aspirin,ticagrelor or clopidogrel load before operation,and basic treatments such as antiplatelet,anticoagulation,heart rate control,lipid reduction and stabilization,and improvement of remodeling were given after PCI.Compare the changes of cardiac ultrasound indexes,biochemical indexes,and inflammatory indexes before PCI,7 days(7d)after treatment with conventional treatment of AMI+ levosimendan or conventional treatment of AMI,including left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),Left ventricular end diastolic diameter(LVEDD),peak mitral valve flow rate ratio(E/A),B-type natriuretic peptide(BNP),blood creatinine(Scr),blood urea nitrogen(BUN),interleukin 6(IL-6)),hypersensitive C-reactive protein(hs CRP);Heart rate,systolic blood pressure,and diastolic blood pressure were compared before and 3 days(3d)after conventional treatment of AMI+ levosimendan or conventional treatment of AMI and the occurrence of adverse reactions(hypotension symptoms,arrhythmia)during drug infusion;The number of days in hospital was compared;the incidence of major cardiovascular adverse events(MACE)within 3 months,including cardiac death,recurrent myocardial infarction,heart failure rehospitalization were compared.Result1.General information of the two groups,such as age,hypertension,diabetes,hyperlipidemia,lung disease,smoking,LDL-C,BMI,Killip classification,blood vessel involvement(specifically including the number of diseased blood vessels,criminal blood vessel classification),etc.In comparison,there was no significant difference(P>0.05).(P>0.05)。2.LVEF after treatment in the two groups were higher than that before PCI,and the difference was significant(P<0.05);and the increase in the levosimendan group was more significantly,[(57.93±1.91)vs(50.33±1.37)P<0.05].After treatment,the LVESD and LVEDD of the two groups were reduced compared with that before PCI,and the difference was significant(P<0.05);and the levosimendan group decreased more significantly,and the difference between the groups was significant(P<0.05).E/A after treatment in the two groups were higher than that before PCI,and the difference was significant(P<0.05);there was no significant difference between the groups(P>0.05),but the E/A increase of the levosimendan group was lower than that of the control group。3.BNP decreased in both groups after treatment compared with that before PCI,and thedifference was significant(P<0.05);and the decrease in the levosimendan group was more significant,[(228.38±62.02)vs(534.12±72.80)P<0.05].After treatment,the Scr and BUN of the two groups were higher than those before the PCI,but the control group had statistical differences(P<0.05),the levosimendan group had no statistical difference,and there was a significant difference between the groups(P<0.05)。4.the levels of IL-6 and hs-CRP decreased in both groups after treatment compared with that before PCI,and the difference was significant(P<0.05);and the decrease in the levosimendan group was more significant,with significant differences between the groups(P<0.05)。5.During the infusion,one case of hypotension(dizziness)occurred in the levosimendan group.After the infusion rate was reduced,the blood pressure returned to normal.There was no arrhythmia during the infusion in the two groups.Three days after treatment,the heart rate,systolic blood pressure,diastolic blood pressure of the two groups had no significant changes compared with those before drug infusion(P>0.05);and there was no statistical difference between the groups(P>0.05)。6.The duration of hospitalization in the levosimendan group was(8.9±1.1)d,and that in the control group was(9.1±1.5)d,and there was no significant difference between the groups(P > 0.05)。7.During the 3-month MACE follow-up,there are statistical differences in the onset of readmission to hospital due to heart failure and recurrent myocardial infarction between the two groups(P < 0.05),There was no significant difference in cardiogenic death(P >0.05).ConclusionThe early infusion of levosimendan after acute myocardial infarction PCI has good tolerance and high safety,which can improve patients’ cardiac function,protect kidneys and reduce inflammation,and may prevent the occurrence of heart failure and recurrent myocardial infarction,which needs to be confirmed by larger and more studies. |
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