Effects of application of lyophilized recombinant human brain natriuretic peptide (rh-BNP) before emergency PCI on no reflow phenomenon, inflammatory factors and cardiac function in patients with acute ST segment elevation myocardial infarction

YANG Ying; SONG Da; GENG Wei

doi:10.3969/j.issn.1002-7386.2018.02.013

Abstract：Objective To investigate the effects of application of lyophilized recombinant human brain natriuretic peptide (rh-BNP) before emergency PCI on no reflow phenomenon,inflammatory factors and cardiac function in patients with acute ST segment elevation myocardial infarction (STEMI).Methods A total of 99patients with STEMI (onset time ＜ 12 hours) who underwent emergency PCI in our hospital from 2013 to 2016 were enrolled in the study.The patients were randomly divided into two groups:research group (n =51) and control group (n =48).The patients in research group were treated by emergency PCI + rh-BNP,however,the patients in control group were treated by emergency PCI only.The thrombolysis in myocardial infarction (TIMI) blood flow grading during PCI,TIMI myocardial perfusion grading (TMPG),the changes of N terminal B type natriuretic peptide (NT-proBNP) levels,the plasma levels of high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) before operation,on 1 w,30d after operation were observed,moreover,the left ventricular ejection fraction (LVEF),left ventricular end-systolic volume index (LVESVI) and wall motion score index (WMSI) were observed and compared between two groups.Results The surgery success rate was 100％ in both groups.The incidence rate of no reflow in research group was significantly lower than that in control group (15.68％ vs 33.33％,P ＜ 0.05).The proportion of the grade Ⅲ of TIMI blood flow grading in research group was significantly higher than that in control group (84.32％ vs 66.67 ％,P ＜ 0.05),moreover,the proportion of grade 3 of TMPG was significantly higher than that in control group (74.50％ vs 45.83％,P ＜ 0.05).In addition,the plasma levels of NT-proBNP,hs-CRP,TNF-α and IL-6 on 1w,30d after operation were significantly decreased in both groups (P ＜ 0.01),moreover,the levels of these indexes in research group were significantly lower than those in control group (P ＜ 0.05).The levels of LVEF were increased gradually with the time going on 1 w,4w,3m after operation in both groups,however,the levels of LVESVI,WMSI were decreased gradually with the time going on,moreover,there were significant differences in the levels between 3m after operation and 1w after operation in both two groups (P ＜ 0.05).As compared with those in control group in every time point,the levels of LVEF were increased at certain degree and the levels of LVESVI and WMSIwere decreased in research group,there were significant differences in the levels on 3m after operation between two groups (P ＜ 0.05).Conclusion The application of BNP before PCI can effectively improve the reperfusion of ischemic myocardium of patients with STEMI,prevent intraoperative no reflow and improve cardiac function and clinical prognosis.