Clinical Observation Of Rho Kinase Inhibitor In Patients With Acute Myocardial Infarction After Direct PCI

Objective:This study was carried out to observe and compare whether there hasdifferent clinical efficacy between the test group(fasudil of Rho kinase inhibitor) andthe control group (conventional medicine) in patients with acute myocardial infarctionafter direct PCI.If so,we want to explore its mechanisms in inhibiting of cardiomyocyteapoptosis, reperfusion injury, ventricular remodeling in AMI patients,which would leadto conserving more functional myocardial cells,and holding back ventricular hypertrophyand cardiac failure.What is more,we want to provide a new drug target for improvequality of life and long-term prognosis.Methods:Selecting patients was on the basis of diagnostic criteria, inclusion criteriaand exclusion criteria of this trial’s.There were a total of57acute myocardial infarctionhospitalized patients (41men,16women) were enrolled from the Affiliated Hospital ofYan’an University from June2011to January2013.All patients were received coronaryangiography (CAG) checks and percutaneous coronary intervention.Then we dividedthem into two groups according to the culprit artery showed by the CAG results andgender with stratified randomization:the control group (conventional treatment group for30cases)and the test group (fasudil group for27cases). Both groups were givenconventional drug therapy based on clinical symptoms and “the acute myocardialinfarction diagnosis and treatment guidelines of Chinese Medical Society of Cardiologyin2011”for a seven days’ therapy.The test group was administrated an extra drug:Rhokinase inhibitors-Fasudil Hydrochloride Injection (60mg/day) into5%glucosesolution or0.9%saline250ml with slowly intravenous infusion.Index of efficiency andsafety:1.The frequency and duration of angina pectoris, frowsty bosom and breathless aswell as untoward reaction during the therapy. Estimating the alter of cardiac function’s degree and depression of ST segment.The major cardiac events in the three monthsfollow-up period.2.Brain Natriuretic Peptide (BNP) and High sensitive creative reactiveprotein would be tested at the beginning and ending point of the drug treatment.Theechocardiography diagram (UCG)would be checked within1week of admission and3months after treatment;Done a recorded of the adverse reactions and major cardiacevents during the drug treatment in patients within three months of follow-up. At thelast,we would collect and collate relevant data using the application SPASS17.0datastatistical analysis software.Results:1.Clinical symptom and untoward reaction:there were two cases of anginawith the time less than5minutes,4cases of frowsty bosom in A group while1case in Bgroup.2.The number of Ⅲgrade for cardiac functional reduced,and yet the Ⅰgrade’sraised compared with pretherapy.3. The number of depression of ST segment≥50%is22in group A and20ingroup B.Compared the later to before，there were4cases increased in group B and1case in group A.4.BNP:we compared respectively the dates of control and test group with the priortreatment’s.BNP were significantly reduced, with a significantly statistical difference(control group: from376.1±34.38to135.6±42.1, P <0,05; test group reduced from359.5±35.2to101.3±20.5, P <0.05); There was still a statistically significant whencontrol group via test group (P<0.05)5.Hs-CRP: the Hs-CRP degree were34.3±6.5mg/ml in group A and33.4±5.8mg/ml in group B，After the test，the degree cut to10.2±5.3mg/ml and7.3±5.2mg/ml.6. Echocardiog-raphic:within the two groups, left ventricular end diastolicdiameter、left ventricle end diastole volume and left ventricle end systolic volume alltend to be decreased than before administration;left ventricular Fractional shortening andthe ejection fraction had a increased tend. Group A: LVEDD from(46.7±5.1) mm to (44.0±5.2) mm, LVESV from(60.6±13.5) ml to(56.5±13.6). LVEDV from(142.4±12.4) ml to (123.5±11.2) ml; FS from (23.1±3.2)%to (32.3±4.4)%, EF from (41.3±6.2)%to (43.2±8.1)%; B group: LVEDD from(47.3±4.3) mm to (41.4±4.4)mm,LVESV from(61.4±12.6) ml to (52.6±13.2) ml, LVEDV from (151.0±16.2) to(101.0±12.4) ml, FS from(19.3±3.2)%to (26.1±6.4)%, FS from(40.5±7.3)%to(48.2±9.1)%(P <0.05). T-test indicts a of statistically significant difference betweentwo groups.7.The untoward reaction and major cardiac events during follow-up:there was onecase of sudden cardiac death in group A. None case of intracranial hemorrhage andshock happened in both of two groups.Conclusions:1. Test group with plus short time rho inhibitor can reduce thesymptoms of myocardial ischemia.2.Rho inhibitor can improve the grade of killip,systolic and diastolic function aswell as left ventricular ejection fraction and shortinig.3. It can also significantly lower BNP which has relation with ventricular walltension and the degree of heart failure.4. Rho inhibitor can increase myocardial blood supply and reduce the inflammation.5. Rho inhibitor can held back LVEDD LVESV and LVEDV indicators’level.Consequently,it will be held back further in ventricular remodeling and heart failure.