Preventive And Therapeutic Effect Of Xintongning Prescription On Perioperative Myocardial Injury In NSTE-ACS Patients With PCI

Objective: To explore the preventive and therapeutic effects of Xintongning Prescription on PCI-induced myocardial injury in patients with non-st segment elevation acute coronary syndromes(NSTE-ACS),who selected PCI therapy before operation.Methods: 78 patients with NSTE-ACS whose were hospitalized in our hospital for elective PCI were admitted from January 2018 to January2019.These patients were randomly divided into treatment group(n = 38)and control group(n = 40).On the basis of the routine western medicine treatment which is also treated in control group,the patients in the treatment group were given Xintongning Prescription for at least 3 days before PCI therapy and last7 days after PCI therapy.We evaluated the clinical efficacy of traditional Chinese medicine after treatment between two groups of patients.Meanwhile,the levels of serum CK-MB,cTnT,CK,hs-CRP,SOD,ACE and AngII were compared between the two groups preoperative and postoperative.We evaluated cardiac function through preoperative and postoperative cording to serum NT-proBNP levels,cardiac color doppler ultrasonography.These patients were followed up for 1 month to compare the incidence of major or adversecardiac events(MACE).Results: 1.Baseline condition: There was no significant difference in general(age,sex),risk factors(smoking,drinking),body mass index,related medical history,coronary angiography results,PCI and routine examinationbetween two group.2.Comparison of clinical efficacy of traditional Chinese medicine in two groups: The total effective rate in the treatment group which was 82% was better than in the control group which was 70%(P < 0.05).3.Detection of serum CK-MB,cTnT,CK level in two groups: The level of serum CK-MB,cTnT,CK at 24 hours and 48 hours after PCI in treatment group reduced significantly than cantrol group(P < 0.05 or < 0.01),but at8 hours after PCI(P > 0.05).In both groups,the level of serum CK-MB,CK at 48 hours after PCI reduced significantly compared with that those before PCI(P < 001),the same goes for serum cTnT at 48 hours after PCI in treatment group.4.Detection of serum hs-CRP,SOD level in two groups:The level of serum hs-CRP at 8 hours,24 hours and SOD at 8 hours after PCI was no significant difference in two group(P > 0.05).The level of serum hs-CRP at 48 hours and SOD at 24 h,48 hours after PCI in treatment group improved significantly(P< 0.05or< 0.01).In both groups,the level of serum hs-CRP,SOD at 48 hours after PCI improved significantly than those before PCI(P < 0 01).5.Detection of serum ACE,AngII level in two groups: The level of serum ACE,AngII in the treatment group was reduced significantly than that in the control group on the 7th day after PCI(P <0.05).In both groups,the level of serum ACE,AngII on the 7th day after PCI improved significantly than those before PCI(P < 0.05).6.Cardiac function improvement: In both groups,the result of NT-proBNP,EF,CO,ESV on the 7th day after PCI improved significantly than those before PCI(P < 0.05).Except for EF,CO,The result of NT-proBNP,ESV in the treatment group was reduced significantly than that in the control group on the 7th day after PCI(P < 0.05).7.Follow-up: There was no significant difference in the incidence of MACE between the two groups within 30 days after PCI(P > 0.05).8.Safety index and adverse reaction: Blood routine,utine routine,stool routine,liver function,renal function,electrolyte,blood lipid,blood sugar,coagulation function and Hcy had no abnormal changes(P > 0 05).There were 1 case in the treatment group and 2 cases in the control group,respectively.After treatment,the gastrointestinal bleeding was improved and no adverse reaction was observed in other systems.Conclusion: Pretreatment of NSTE-ACS patients with selective PCI with Xintongning Prescription can decrease serum myocardial enzymes,myocardial markers,inflammatory factors,vasoconstrictors,and increase the level of serum antioxidant factors.Xintongning prescription may inhibit inflammatory reaction,alleviate oxidative stress reaction,antagonize ACE-AngII-AT1 R axis to reduce PMI,restrict abnormal ventricular wall movement to improve cardiac function,and Xintongning Prescription has low side effects,so it is safe and effective in clinical application.