The Safety Research About RhBNP In Acute Myocardial Infarction Patients Undergoing Emergency PCI With Heart Failure And Mild Renal Insufficiency

Objective: This reserash was designed for acute myocardial infarctionpatients with heart failure and mild renal insuggiciency after pPCI, usingrecombinant human brain natriuretic peptide (rhBNP) contrasted withnitroglycerin (NIT), observe the changes of patients' renal function, to explorethe safety effect about rhBNP in renal fuction.Methods: Selected patients from June2010to February2012hospitalized in cardiology department of The Second Hospital of HebeiMedical University, suffered from acute myocardial infarction in24hours,simultaneously with heart failure and mild renal insufficiency, a total of64cases,46cases were male and18were famales, age from46-74, mean agewas60.95±8.07years. Inclusion criteria:1, compliance with the2007globalacute myocardial infarction criteria: the levels of cardiac biochemical markers(cTnI) elevated or lower than99%of the reference value, as same as one ofthe following ischemic evidence:(1) new ischemic ECG changes, new ST-Tchanges or new left bundle branch block(LBBB), electrocardiogram promptedthe formation of pathological Q wave or radiographic evidence suggest newsegmaental wall motion abnormalities of myocardial viability loss;(2) suddencardiac death(cadiac arrest),with symptoms of myocardial ischemia, and(or)new thrombosis evidence confirmed by coronary angiography;(3) acutemyocardial infarction finding by pathologic evidence.2, Meanwhile,accompanied by heart failure, Killip Ⅱ/Ⅲ grade, and left ventricular ejectionfraction(LVEF)＜40%;3, accompanied by mild renal insufficiency: serumcreatinine(Scr)＞1.0mg/dL(Scr≥88.4μmol/L), creatinine clearance (Ccr) orestimated the glomerular filtration rate(eGFR)＜90ml/min, and＞50ml/min;cysteine proteinase inhibitor(CysC)≥1.03mg/dL, and≤1.56mg/dL. Exclusion criteria:(1) Non-ST segment elevation myocardial infarction;(2)with mechanical complications, with cardiac shock, hypotesion, hypovolemia,not suitable for vessels dilation drugs.(3) easy allergies patients, allergy tocardiovascular therapy drugs, or allergy to contrast agent;(4) patients withsevere liver dysfuction, or renal insufficiency;(5) existence of infectiousdiseases, autoimmune diseases, severe trauma, homorrhagic disease,or withtumor;(6) age≥75years;(7) patients after thrombolytic therapy;(8) patientswith PCI contraindication;(9) patients themselves or other family membersrefused to participate in this study. After selected the patients, using therandom digital table, randomly divided them into two groups, the rhBNP(recombinant human brain natriuretic peptide) group and theNIT(nitroglycerin) group. There are30cases in the rhBNP group and other34cases in the NIT group. The rhBNP group immediately given lyophilizedrecombinant human brain natriuretic peptide (rhBNP, Tibetan medicine),intravenous the loading dose of1.5μg/kg, then intravenous at the starting doseof0.0075μg/kg/min,ensure the systolic blood pressure≥90mmHg, adjustedthe mantenance dose range from0.0075μg/kg/min to0.020μg/kg/min. TheNIT group intravenous of introglycerin,start at the dose of20μg/min, thencarefully adjusted the dose range from10μg/min to100μg/min,both twogroups should close monitoring by experience physicians. All cases shouldwell-prepared for emergence PCI, and underwent the emergency coronaryartery angiography and implanted metal stent. All stent chose Endeavor drug-eluting stents. Using non-ionic, low-permeability contrast agent. Afteradmitted to hospital, all patients' relevant index should be monitored.Including serum creatinine(Scr) and calculation of creatinine clearance rate(Ccr), cystatinC (CysC), β2-microglobulin (β2-MG) changes. Monitoringthese index both in baseline, and6hours,24hours,48hours,72hours afterthe PCI.Monitoring the urine specific gravity the first postoperative day,thethird day after PCI.Observe the incidence of MACE events of the two groups,the postoperative contrast induced nephropathy incidence. Application the SPSS18.0statistical software to analyse the monitoring data. Using P＜0.05as significant statistically difference, have statistical significance.Results:1The rhBNP group compared with the NIT group, there were no significantdifference in gender, age, weight, diabetes and hypertension incidence. In thetime of admission, both two groups' baseline data in ejection fraction, killipgraded, renal function, serum creatinine, blood urea nitrogen, endogenouscreatinine clearance rate,cystatin C levels, as well as drug uses, showed nosignificant difference.2There was no significant differences in the dose of contrast agent using inPCI. After PCI, the dose of sodium chloride liquid using also have nosignificant difference. No significant difference in HCT before and after PCIboth between and within groups. Also no significant difference between twogroups of patients both in the location and quantity of coronary artery lesion.3Changes of renal fuction in the two groups.The baseline serum creatitine level of rhBNP group were116.05±14.43μmol/L,6hours and24hours after the PCI operation, the creatinine levelincreased (121.64±11.03μmol/L and128.88±10.62μmol/L),48hours afterPCI, the values began to fall (121.25±10.12μmol/L), and at the point of72hours, the creatinine values dropped to below baseline levels(112.54±14.31μmol/L). At the group of NIT, the serum cretinine baselinevalue was113.68±13.25μmol/L,at the6hours,24hours,48and72hoursafter PCI, Scr was126.25±9.56μmol/L,130.19±12.23μmol/L,123.85±10.73μmol/L,113.46±10.34μmol/L, and the postoperative serum criatinine trendwas as same as rhBNP group, but increased more than the rhBNP group.There were no significant difference between rhBNP group and NIT group invalues of postoperative serum creatinine. And the NIT group value increasedmore.The values of rhBNP group in creatinine clearance rate at6hours is lowerthan the baseline. After24hours and48hours, the values also decreasesignificantly. At72hours, the values rebounded close to baseline values. Of the NIT group, the creatinine clearance rate trend same as rhBNP group, andat the72hours after pPCI, the creatinine clearance rate is still high comparedwith the baseline value. There also no significant difference between twogroups.About the cystatin C level (mg/L), the values of rhBNP group at baseline,after PCI6hours,24hours,48hours,72hours were1.29±0.16,1.48±0.16,1.71±0.16,1.46±0.14,1.38±0.12. And the NIT group values were1.28±0.14,1.50±0.17,1.71±0.17,1.50±0.19,1.46±0.14. The peak level of both twogroups appeared at24hours after PCI, and latter began to fall. There were nosignificant statistically difference between the two groups in6,24,48hoursafter PCI, but at72hours value compare, there were differences.The value inrhBNP group fall down better than the NIT group (N=0.018). Have statisticalsignificance.About the β2-microgloblin levels, the values rise continued within48hours, the peak appeared at24hours in the NIT group, and the peak appearedat48hours in the rhBNP group. At the72hours after PCI, the β2-microgloblin levels of two groups have fall down nearly the baseline. Nosignificant differences was found in the two groups.Patients in both groups urine specific gravity baseline were slightly higherthan the normal range. At the first day morning, the gravity lower, and at the3days morning urine after PCI, the value nearly normal. No significantdifference between the two groups.4There were each1case of MACE in both two groups occur until the72hours after PCI,all malignant arrhythmia, no death cases, and no significantdifference between two groups. There were3cases occur CIN in the rhBNPgroup(10.00%), and there were4cases of CIN in NIT group(11.76%), theCIN incidence is lower than the incidence reported in the literature, the CINoverall incidence of AMI patients after PCI is13-19%. No significantdifference have found in two groups (P=0.821).Conclusion:1Compared with the NIT group, the use of rhBNP in acute myocardial infarct -ion complicated by heart failure and mild renal insufficiency patients, didn'tlead to serum creatinine elevated significantly, and didn't deteriorated otherrenal fuction observations. The use of rhBNP is safe.2Compared with the NIT group, the use of rhBNP in patients after emergencePCI, the renal function recovery rapidly.3Mild renal insufficiency patients undergoing emergency PCI treatment issafe, no CIN incidence increased, and no severe renal insufficiency occurred.