| Objective:Observe the clinical efficacy of levosimendan in patients with Acute Myocardium Infarction(AMI)who underwent Percutaneous Coronary Interventio(PCI)in the perioperative period,and Major Adverse Cardiovascular Events(MACE),and explore the effectiveness and safety of levosimendan in patients who underwent PCI in AMI in the early stage.Methods:From January 2019 to December 2021,patients with AMI who underwent emergency PCI at Qingdao Municipal Hospital were taken as the main study subjects,129 patients were included and divided randomly into two groups by applying the random number chart method: Control group of 64 patients,who were given conventional treatment,including Aspirin,Ticagrelor or Clopidogrel loading followed by emergency PCI and standardized basic treatment such as beta blockers,RAS blockers,statins to control heart rate,reduce blood lipids and stabilize plaque;In the levosimendan group,65 patients were treated with levosimendan injection(continuous pumping at 0.1ug/kg/min for 24h)during the perioperative period on the basis of conventional treatment.The patients in the two groups were further divided into subgroups such as the anterior descending branch group and non-anterior descending branch group according to the diseased coronary arteries.Basic information of the patients was recorded and collected information on the observed indices of the study subjects before and after treatment(below).1.Basic Information:Gender,age,history of smoking,body mass index(BMI),contrast dose,time of onset,number of coronary artery disease vessel and culprit vessel,and complicated with hypertension,diabetes,hyperlipidemia.2.Observation Indices Information:Tests:Cardiac troponin I(cTnI),N-terminal pro-B-type natriuretic peptide(NT-proBNP),Estimated glomerular filtration rate(eGFR),Serum creatinine(Scr),Blood urea nitrogen(BUN),C-reactive protein(CRP);Examination:Two components of left ventricular end diastolic diameter and left ventricular ejection fraction and,namely: LVEDD and LVEF;Other: Cardiac Functional Class(NYHA),patient hospitalization period,MACE within 1 year,such as recurrent AMI,status of readmission for concomitant heart failure,etc.Result:1.The various data of the general information of the two groups of patients designed can be seen by comparison,the differences are not statistically significant and will not affect the analysis of the later study.2.There was no statistically significant difference in the preoperative/immediate postoperative ultrasound indices between the two groups of patients.At 3 months after treatment,LVEF increased in both groups compared with pre-PCI,and the difference was statistically significant(P < 0.05);moreover,the levosimendan group showed a mean increase of 7.76 in LVEF,which was more significant compared with the 2.37 increase in the control group.After the treatment,LVEDD of the two groups decreased compared with that before operation.The decreasing trend of levosimendan group was significantly better than that of the control group(6.2 vs 2.56).The difference between the two groups was significant and had statistical value(P < 0.05)(according to the characteristics of the lesion,only the analysis of ultrasound indices of patients in the anterior descending branch group was performed in this section).3.The differences in cTnI,CRP and BNP before treatment between patients in the levosimendan group and the control group were not statistically significant(P>0.05);After treatment,as the disease progressed,hs-c Tn I,NT-pro BNP,and CRP increased in both the levosimendan group and the control group,but the median peak values of hs-c Tn I,NT-pro BNP,and CRP in patients in the levosimendan group(control group)were 44.84(48.69),614(1024.5),and 9.74(13.85),which shows that the increase in hs-c Tn I,NT-pro BNP,and CRP was greater in the control group after treatment compared with the observation group in which levosimendan was applied during the perioperative period(P< 0.05);After 7 days of treatment,the median hs-c Tn I recovered to 2.42(4.71)in the two groups of patients,respectively,with better recovery in the levosimendan group(P <0.05).4.There was no statistically significant difference in Scr,e GFR,and BUN between the two groups before treatment(P>0.05).7 days after treatment,the mean Scr of patients in the levosimendan group(control group)was 79.21(84.92),a decrease from preoperative;The mean e GFR and BUN of patients in the levosimendan group(control group)were 89.88(83.22)and 5.54(6.33),respectively,which were higher than those before surgery,and the difference was significant and had a statistical value(P < 0.05).5.Three days after treatment,there were no significant changes in heart rate and blood pressure in the levosimendan and control groups compared with those before medication(P > 0.05);the difference between groups was small and had no statistical significance(P > 0.05).6.No statistically significant difference between the groups in the number of days of hospitalization of patients in the levosimendan group and the control group(P > 0.05).7.At the one-year follow-up of MACE events,the number of patients with heart failure and relapse of myocardial infarction in the levosimendan group was 2 and 1,respectively,while in the control group it was 7 and 8,respectively,with significant differences with statistical value(P < 0.05).Conclusion:1.The patients in the observation group treated with levosimendan during the perioperative period showed better improvement in cardiac function than the control group.2.hs-c Tn I,NT-pro BNP,and CRP are essential markers of cardiac lesions,myocardial injury,and inflammatory response,so patients in the levosimendan group had less myocardial injury than the control group.3.The improvement in renal function was more effective in the levosimendan group than in the control group.4.Patients in the levosimendan group had a lower chance of complicated heart failure and recurrent myocardial infarction than the control group.In this single center study with small sample size,it was found that initiating levosimendan therapy early in the perioperative period of PCI in AMI patients could better exploit its benefits in enhancing cardiac function,reducing myocardial injury,and improving renal function with a high safety profile,reducing the occurrence of heart failure,recurrent myocardial infarction,and other complications,with a positive effect on improving the prognosis of AMI patients.This study is an exploratory study and further studies need to be carried out in multiple centers to increase the sample size to confirm the results. |
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