| Objective: This study was aimed to investigate the effects of recombinant human brain natriuretic peptide(rh BNP)on ventricular function in elderly patients with acute anterior myocardial infarction after primary percutaneous coronary intervention(pPCI).Methods: A total of 63 consecutive elderly patients(65 years old or older,average 69.09±2.93 years old)with acute anterior myocardial infarction after primary percutaneous coronary intervention hospitalized in the second hospital of Hebei medical university from Jaunary 2015 to December 2016 were enrolled ino this study.They were randomly assigned to either receiving recombinant human brain natriuretic peptide(rhBNP group,n=32)or nitroglycerin(NIT group,n=31)according to the random number table.Two groups of patients were respectively given 300 mg aspirin and clopidogrel hydrogen sulfate 300 mg of chewing in preoperation,atorvastain 40 mg orally after undergoing PCI to routine use of anticoagulants,antiplatelet,lipidlowering,angiotensin converting enzyme inhibitor(ACEI)or angiotensin receptor antagonist(ARB),beta blockers,nitrates and spironolactone and so on.Two groups of patients were given conventional treatment.Under the conditions of stable hemodynamics and systolic blood pressure not less than 90 mmHg,the patients in rh BNP group were treated with intravenous rhBNP with a 1.5μg/kg·min intravenous bolus injection followed by 0.0075-0.030μg/kg·min iufusion for 72 hours.During the treatment,the pumped dose was adjusted according to patient’s symptoms and systolic blood pressure(not less than 85mmHg)and mean arterial pressure(not less than 65mmHg)until reached the maximum tolerated dose within 6 hours with which rhBNP was continuously intravenous pumped for 72 hours.While the patients in NIT group were given Nitroglycerin continuously with the dose of 10μg/kg·min initially under the same conditions such as stable hemodynamics and systolic blood pressure not less than 90 mmHg.During the treatment,the pumped dose was ranged from 10μg/kg·min to 100μg/kg·min according to patient’s symptoms and systolic blood pressure(not less than 85mmHg)and mean arterial pressure(not less than 65mmHg)until reached the maximum tolerated dose within 6 hours with which nitroglycerin was continuously intravenous pumped for 72 hours similarly.The basic clinical data of patients were recorded,including age,gender,smoking,disease of history(hypertension,diabetes and hyperlipidemia),Killip classification,creatinine clearance rate,clinical time,time of revascularization and clinical medication.Before and after treatment,the indexes were observed and analyzed statistically,including heart rate,respiratory rate,systolic pressure,the plasma NT-proBNP concentrations,the difference value between input and output in 24 hours,peak value of CK-MB,cTnI and echocardiography examination.Echocardiography examination include:(left ventricular ejection fraction)LVEF,E/e,,(left ventricular end diastolic diameter)LVEDD and(left ventricular end systolic diameter)LVEDD.Meanwhile,the adverse reactions were recorded during treatment including allergies,hypotension,acute renal dysfunction and ventricular arrhythmias.We followed up the level of NTproBNP,echocardiographic parameters for one month and major adverse cardiac events(MACEs)for three month.All statistic data were analyzed with SPSS 20.0,P<0.05(2-tailed)was considered statistical significance.Results:1 The baseline data including: age,gender,smoking,hypertension,respiratory rate,heart rate,Killip classification,creatinine clearance rate,first medical contact time,time of onset to revascularization,the application of tirofiban and other conventional drug treatment showed no statistical difference between two groups of patients(P>0.05).2 The respiratory rate slowed down significantly compared with baseline after treatment of 24 h,72h(P<0.05),which in rhBNP group was more significant than that in NIT group(P<0.05).The heart rate declined obviously compared with the baseline(P<0.05)after treatment which was more significant in rh BNP group at 24 hours and 72 hours.Compared to the baseline value,the systolic pressure was markedly lower in rhBNP group than that in NIT group at 24 hours and 72 hours after treatment(P<0.05).Two groups of patients after treatment for the first 24 hours and the third 24 hours,the difference value between input and output in 24 hours were statistically significant(P<0.05),and the rhBNP group was significantly higher than that in NIT group.3 The peak value of CK-MB and cTnI was lower in rhBNP group than that in NIT group,and the difference was statistically significant between the two groups(P<0.05).4 There was a statistically significant about the plasma NT-proBNP oncentrations between the two groups of patients in the treatment of 72 hours,after 7 days comparing with the baseline,and in rhBNP group which was significantly lower than that in NIT group.Whlie at the 1st month after treatment the plasma NT-proBNP concentrations was measured again,there was no statistic difference between the two groups.5 The value of LVEF,LVEDD and LVESD had no statistic difference after one week treatment between the two groups,however the statistic difference was seen at the 1st month after treatment.The value of LVEDD and LVESD was decreased compared with that at one week after treatment,and which in the rhBNP group was more obvisouly.The value of LVEF showed the statistical significance,which in rhBNP group was more higher than that in NIT group.The value of E/e,in rhBNP group was more significantly improved than that in NIT group at 1 week and 1 month after treatment.6 The allergic reaction was not observed in both groups during the course of treatment.The renal insufficiency was not obtained and the original renal insufficiency was not worsened in both groups.The hypotension was found in 1 case of the rhBNP group and 2 cases of the NIT group,which did not happen again by adjusting the dosage,the incidence of hypotension phenomenon had significant difference between the two groups(P>0.05).There was no patient in the rhBNP group suffered from headache,while the 5 cases of patients were tolerated in the NIT group,the incidence of headache was higher in NIT group than that in rh BNP group(P<0.05).The malignant arrhythmia did not appear in rhBNP group,frequent premature ventricular contractions was found in 2 cases of NIT group,which did not occuer after giving corresponding antiarrhythmic therapy.There was no significant difference about incidence of ventricular arrhythmia(P>0.05).The acute kidney injury was not found between two groups of patients during treatment.7 The patients were told to respectively peform dynamic electrocardiogram at 1 weeks,1st and 3rd month after discharge.During the 3 months of follow-up,there was one case of severe ventricular arrhythmia in rhBNP group,while two cases in NIT group.The incidence of severe ventricular arrhythmia had no significant difference between two groups.There was one case of recurrent angina in rhBNP group,while three cases in NIT group.The incidence of recurrent angina had no significant difference between two groups.There was no patients with heart failure deterioration in rhBNP group,while two cases in NIT group.The incidence of heart failure deterioration had no significant difference.There was no case of sudden cardiac death in both groups.Conclusions: For those elderly patients with acute anterior myocardial infarction undergoing primary PCI,rhBNP could stabilize hemodynamics and improve cardiac function. |
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