Effects of recombinant human brain natriuretic peptide and nitroglycerin on myocardial ischemia and cardiac function in non-ST elevation ACS patients with AHF

SUN Yong; CAO Huai-fang; Wang Gang; JI Juan-juan; MIAO Dong-dong

doi:10.3969/j.issn.1674-4055.2016.10.22

Abstract：Objective To compare the effects of recombinant human brain natriuretic peptide (rhBNP) and nitroglycerin (NIT) on myocardial ischemia and cardiac function in patients with non-ST Elevation acute coronary syndrome (ACS) and acute heart failure (AHF).Methods 92 patients with ST-segment elevation ACS and AHF were randomly divided into rhBNP group and NIT group, 46 patients in each group, based on conventional therapy, rhBNP group was treated with rhBNP, NIT group was treated with NIT. The blood pressure, NT-proBNP, creatinine (Cr), Killip classification, angina pectoris, cardiac function and echocardiographic parameters of both groups were recorded before and after treatment. The incidence of adverse events and cardiac adverse events in the two groups were recorded.Results After treatment, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), arterial oxygen pressure (PaO2), NT-proBNP and Cr of the two groups were significantly lower than those before treatment (P<0.05). The levels of SBP, DBP, HR, PaO2 and NT-proBNP were significantly decreased in rhBNP group than those in NIT group at 24 h and 72 h after treatment (P<0.05). There was no significant difference between the two groups with respect to Cr (P>0.05). The Killip classification, incidence of angina pectoris, the number of total leads (NST) and the total number of sum (ΣST) were significantly improved (P<0.05), and the improvement effect was more obvious in rhBNP group (P<0.05). After 1 week, the left ventricular ejection fraction (LVEF) of both groups was significantly higher than that before treatment (P<0.05). Left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were significantly higher in both groups than those before treatment (P<0.05), and the improvement effect was more obvious in rhBNP group (P<0.05). The incidence of MACE in the NIT group was significantly higher than that in the rhBNP group at 1 month after treatment. The incidence of hypotension, hypokalemia, hyponatremia and other 3 types MACE events were no significant differences between the two groups (P<0.05). The incidence of headache and ventricular arrhythmia was statistically significant different (P<0.05). Conclusion Intravenous use of rhBNP in the treatment of non-ST-segment elevation ACS with AHF can significantly improve the patient's myocardial ischemia and cardiac function, and drug safety and more reliable.