Protective Effects Of Phosphocreatine On Heart And Kidney In Patients With Coronary Heart Disease Treated By Percutaneous Coronary Intervention

Background:Percutaneous coronary intervention(PCI)is the treatment of cardiac catheterization techniques to clear the stenosis or even occlusion of the coronary artery lumen,thereby improving the treatment of myocardial blood flow and reperfusion.It can significantly improve the patient's long-term prognosis.However,myocardial ischemia and reperfusion injury and contrast agent renal injury in PCI are the most common serious complications,which increase patient mortality and rehospitalization rate.Phosphocreatine as the main way of energy storage of cardiomyocytes which can quickly provide energy for myocardial ischemia and hypoxia damage.Studies have confirmed that preoperative use of exogenous phosphocreatine on the heart of a protective effect.There is no clinical study that in the preoperative application of exogenous phosphocreatine in the heart and kidney will have a protective effect.Objective: 1 To investigate the myocardial injury induced by percutaneous coronary intervention and to evaluate the myocardial protective effect of phosphocreatine by detecting the concentration of cTnI.2 To detect the changes of serum creatinine,urea nitrogen and cystain C and other renal injury markers,and to calculate the incidence of contrast nephropathy,to evaluate the protective effect of exogenous phosphocreatine on contrast agent kidney injury.3 To evaluate the safety of phosphocreatine in percutaneous coronary intervention.Methods:Included 80 patients admitted to hospital for coronary intervention.All patients were in line with the 1979 WHO diagnostic criteria for coronary atherosclerotic heart disease.According to the patient hospitalization number were randomly divided into experimental group and control group.There were 40 patients in each group.Phosphocreatine group was given intravenous of phosphocreatine before percutaneous coronary intervention.Control group was given the same dose of physiological saline.Intravenous infusion was performed within 30 minutes before coronary intervention.The peripheral venous blood was collected before and 2,4,8,24 hours after PCI.Then measured the levels of serum creatinine,urea nitrogen and cystain C at each time point.Results :1)Preoperative basic situation:There was no statistical difference in age,bodymass index,hospitalized blood pressure,left ventricular ejection fraction,fasting blood glucose,troponin I,creatine kinase isoenzyme and cystatin C among the experimental group and control group(P>0.05).There was no statistical difference in the proportion of patients with sex,smoking,hypertension,diabetes mellitus,heart function and ?and family history of coronary heart disease among the experimental group and control group(P>0.05).2)Surgical condition:There was no statistical difference in the amount of contrast agent,the number of coronary artery lesions,the number of stents placed and the proportion of interventional therapy among the experimental group and control group(P>0.05).3)Adverse events occur:There was no significant defference in the incidence of adverce reaction among all the groups(P>0.05).4)Electrolyte condition:There was no statistically significant difference between the two groups in postoperative electrolyte level compared with preoperative(P>0.05).There was no significant difference in the serum potassium levels between the two groups at each time point(P>0.05).The incidence of hypokalemia:Phosphocreatine group 2.50%(1/40),Control group7.50%(3/40),There was no statistical difference in the incidence of hypokalemia among the experimental group and control group(?2=0.265,P=0.607).The overall incidence of hypokalemia was 6.25%(5/80)?There was significant difference between the two groups in serum phosphorus level at 8h postoperatively(t=0.901,P=0.045).The incidence of Hypophosphatemia :Phosphocreatine group 62.50%(25/40),Control group 60.00%(24/40),There was no statistical difference in the incidence of Hypophosphatemia among the experimental group and control group(?2=0.068,P=0.794).There was significant difference between the two groups in serum calcium level at 8h postoperatively(t=0.785,P=0.005).There was significant difference between the two groups in serum calcium level at24 h postoperatively(t=-0.655,P=0.024).There were no hypocalcemia in both groups.5)Liver function:There was no statistically significant difference between the two groups in AST level and ALT level between the two groups(P>0.05).compared with preoperative(P>0.05).The incidence of liver damage in the control group was 5.00%(2/40).6)Myocardial injury:Two groups of troponin were statistically different at 8 and 24 hours postoperatively(P>0.05).Two groups of troponin at different time points compared withpreoperative statistical difference(P<0.001).7)Renal function:There was statistically significant difference in creatinine level at 2and 24 hours compared with preoperative in the control group(P<0.05).The levels of urea nitrogen in the two groups of 2,4,8 hours were statistically different from those before operation(P<0.05).The glomerular filtration rate was significantly different from that of the control group 2 hours after operation(P<0.05).The cystain C was significantly different from that of the control group 4 hours after operation(t=6.636,P<0.05).8)The incidence of contrast nephropathy:The incidence of contrast nephropathy in the control group was 5.00%(2/40).There was a statistically significant difference in the incidence of nephropathy between the two groups(P<0.05).9)Logistic Regression Analysis of Risk Factors of CIN:Diabetes(OR=13.33,95%CI1.36-130.31,P=0.026)and contrast agent dosage?200m L(OR=10.00,95%CI 1.04-96.38,P=0.046)is an independent risk factor for contrast agent nephropathy.Conclusions:1.Exogenous creatine phosphate has a significant protective effect on myocardial injury during coronary intervention.While reducing the incidence of contrast agent nephropathy during interventional therapy.2.Before coronary artery intervention treatment of hydration while largely reduce the emergence of contrast nephropathy,But postoperative serum creatinine,blood urea nitrogen and urinary volatile inhibition C level fluctuated significantly.Dynamic monitoring indicators help to early detection of kidney damage.Before interventional therapy of hydration can also cause blood phosphorus,potassium,such as blood calcium electrolyte disorder of different level.3.Diabetes and contrast agent dosage?200mL is an independent risk factor for contrast agent nephropathy.