重组人脑利钠肽对行直接经皮冠状动脉介入治疗的急性 ST 段抬高型心肌梗死患者的疗效观察

Beneficial effects of early administration of recombinant human B-type natriuretic peptide in ST-elevation myocardial infarction patients receiving percutaneous coronary intervention treatment.

机构信息

Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, China.

出版信息

Singapore Med J. 2019 Dec;60(12):621-625. doi: 10.11622/smedj.2019093. Epub 2019 Aug 7.

DOI:10.11622/smedj.2019093

PMID:31388683

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7911060/

Abstract

INTRODUCTION

We aimed to evaluate the clinical performance of early administration of recombinant human B-type natriuretic peptide (rhBNP) to ST-elevation myocardial infarction (STEMI) patients receiving percutaneous coronary intervention (PCI) treatment.

METHODS

In total, 185 patients diagnosed with STEMI were enrolled and randomised into either the placebo-treated (n = 88) or rhBNP-treated (n = 97) group. Patients were given either saline or rhBNP ten minutes before PCI and monitored with various cardiac parameters, including accelerated idioventricular rhythm, frequent ventricular premature beat (FVPB), ventricular tachycardia, systolic blood pressure, thrombolysis in myocardial infarction (TIMI) 3 gradation, corrected TIMI frame count (cTFC) and myocardial blush grade (MBG) 3 classification.

RESULTS

Our results revealed no difference in accelerated idioventricular rhythm between the two groups. However, FVPB and ventricular tachycardia were significantly decreased in rhBNP-treated patients compared to placebo-treated patients (p < 0.05). Moreover, the occurrence ratio of reperfusion-associated low blood pressure in rhBNP-treated patients was lower than in placebo-treated patients (p = 0.03), while no difference was observed in infarction-related arteries TIMI 3 blood flow between the two groups (p = 0.23). Importantly, measurement of post-reperfusion blood flow velocity via cTFC suggested that rhBNP treatment could significantly increase blood circulation (p = 0.003). After stent implantation, the acquisition rate of MBG 3 was higher in rhBNP-treated patients compared to placebo-treated patients (p = 0.071), although the difference was not significant.

CONCLUSION

We concluded that early administration of rhBNP can ameliorate the severity of reperfusion injury for STEMI patients receiving PCI treatment.

摘要

简介

本研究旨在评估在接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中早期给予重组人脑利钠肽（rhBNP）的临床效果。

方法

共纳入 185 例 STEMI 患者，随机分为安慰剂组（n = 88）和 rhBNP 组（n = 97）。患者在 PCI 前 10 分钟分别给予生理盐水或 rhBNP，监测包括加速性室性自主节律、频发室性期前收缩（FVPB）、室性心动过速、收缩压、心肌梗死溶栓治疗（TIMI）3 级、校正 TIMI 帧数计数（cTFC）和心肌灌注分级（MBG）3 级等心功能参数。

结果

两组患者加速性室性自主节律发生率无差异。然而，rhBNP 组 FVPB 和室性心动过速的发生率明显低于安慰剂组（p < 0.05）。此外，rhBNP 组与安慰剂组相比，再灌注相关低血压的发生率较低（p = 0.03），但两组患者梗死相关动脉 TIMI 3 级血流无差异（p = 0.23）。重要的是，通过 cTFC 测量再灌注后血流速度，rhBNP 治疗可显著增加血液循环（p = 0.003）。支架植入后，rhBNP 组 MBG 3 级的获得率高于安慰剂组（p = 0.071），但差异无统计学意义。