| Objective:B-type natriuretic peptide (BNP), a cardiac hormone, is secreted predominantly by the ventricular myocardium in response to ventricular wall stress and myocardial ischemia, and it suppresses norepinephrine, endothelin-1, and the renin-angiotensin-aldosterone system and unloads the heart through vasodilatation and natriuresis. rhBNP has been shown to improve symptoms in patients with acutely decompensated CHF. In recently, more and more studies have been observed in patients with acute coronary syndrome (ACS). In this study, we evaluated the effects and the safety of rhBNP by intravenous infusion in patients with AMI and PCI.Methods:(1)Patient Selection:There are total 30 patients with AMI in our hospital attending this study .The institution ethics review board of Liaoning province people'hospital approved the study protocol. We obtained informed written consent from patients after explaining the procedure and risk. Patients above 18 years of age were eligible for inclusion into this study if they had a first acute ST-elevation during 24 hours that was diagnosed as AMI and was treated firstly by coronary stenting where the culprit lesion of the infarct-related artery. The following exclusion criterias were required for patient enrollment: (1) difficulty in obtaining vascular access for percutaneous procedures or ineligibility for percutaneous revascularization; (2) a history of tumor or disease affecting survival in short time; (3) systolic blood pressure consistently﹤90mmHg;(4) serious dysfunction of liver and kidney; (5)valvular disease,cor pulmonale; (6) mechanical syndrome after AMI; (7)revascularization by intravenous imembolism⑧have hypersusceptibility with rhBNP (8) the presence of cardiogenic shock and limited to vasodilator;(9) any condition that, in the judgment of the investigator ,would place the patient at undue risk. All patients were placed on maximally tolerated medical therapy at the time of enrollment.(2)Method and Observed target:30 patients with AMI receiving standard drug and coronary artery intervention therapy (being treated by coronary stenting where the culprit lesion of infarct-related artery), were randomly allocated to two groups. One (A group) was received rhBNP intravenous therapy, firstly at 1.5μg/kg intravenous injection for more than 90 minutes,then for 0.01μg/kg/min intravenous infusion for 24-48 hour; the other (B group) was received placebo(natrum cl) at the same time by intravenous therapy. In the process of the therapy of rhBNP , the following side effects should be paid attention to, such as: hypotention,headache,nausea, etc. BNP, prior to PCI and on the 60 hours,108 hours,156 hours after PCI ; the CK and CK-MB prior to PCI and on the 60 hours,108 hours after PCI in the peripheral blood should be observed. We assessed the left ventricular morphysiam, global left ventricular function and regional wall motion with echocardiography (PHILIPsonos-7500, Siemens, Mountain View, CA, German) at the 5th after AMI and had a follow up 3 months later. (3)Statistics:Continuous numerous variables were expressed as mean value±SD. SPSS 10.0 statistics software were adopted. Differences in variables of A group and B group were assessed by Independent Sample T Test; count variables were assessed by Chi-Square. A value of P<0.05 was considered statistically significant.Results:(1) The counts of serum BNP in two groups were showed: that was decreased with days in two groups. Due to B group (control group), the peak of the counts of serum BNP was at the 24hours after PCI. The counts of serum BNP were significant different at the 156 hours after PCI.(2) The counts of serum CK and CK-MB in two groups were showed: that was not significant different with days. (3) Prior to PCI and after 3 months, EDV and ESV were increased in each group, but they were not significant different and after 3 month EDV and ESV were not significant different in two groups. Due to B group EF was decreased after 3 months but it was not significant different. Prior to PCI and after 3 months, EF in two groups was not significant different. (4) There were total 5 complications in the process of the therapy of rhBNP, and the incidence of complications during mobilization was 33.3 %(5/15), No death had happened.Conclusions:(1)The intravenous therapy of rhBNP for patients with AMI and Direct PCI was feasible and safe.(2) After the intravenous therapy of rhBNP, the level of serum BNP was decreased;(3) After 3 months follow up, cardiac function of patients with AMI between two group was no significant different.
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