Prognostic Impact Of Early Digitaliod Drugs Treatment In Reperfused Acute Myocardial Infarction Complicated With Acute Heart Failure

Objective:To observe and explore clinical efficacy and safety of the early application of digitalis on patients received percutaneous coronary intervention(PCI)therapy with acute myocardial infarction complicated with acute heart failure(AMI-AHF)within 24 hours from onset of symptoms.Methods:60 patients received PCI therapy with AMI-AHF within 24 hours from onset of symptoms were selected in our hospital from June 2016 to June 2017.60 cases were divided into the following two groups: observation group and the control group,each group involved 30 cases.Observation group patients were treated with intravenous injection of sildenafil injection after PCI treatment 2 h at the same time treated with 20 ml 0.9% NaCl injection,the time for injection was 20 min.After the first injection,0.1~0.2 mg sildenafil should be added according to patients condition.The control group patients were treated with intravenous injection of sildenafil injection after PCI treatment 3 days.dose and methods were same as observation group patients.During hospitalization,AMI patients received formal drug therapy,including emergency PCI,anticoagulation and antiplatelet drug treatment,drug therapy,ACEI drugs,diuretic drugs,etc.AMI-AHF patients’ basic information were recorded,which including gender,age,weight,past medical history and myocardial infarction,Killip classification,etc..Before medication and 1 h,3 h,12 h,24 h after medication through different center cavity,we monitored hemodynamic parameters,such as the right room systolic blood pressure(RAP),right ventricular systolic pressure(RVP),central venous pressure(CVP),pulmonary artery systolic pressure(PASP)and pulmonary artery diastolic pressure(PADP),pulmonary capillary wedge pressure(PCWP).Before the medication and 3 h,24 h after medication,Color doppler echocardiography was performed by American GE Logic5 color doppler echocardiography to measure the left ventricular ejection fraction(LVEF),short axial shortening rate(FS);the blood BNP,Tnl,CBMP,ICTP,and MMP-9 levels were measured by kits.The incidence of malignant arrhythmia and mortality were monitored at 24 h after medication within 30 d.Results:(1)There was no statistically significant difference in general clinical data between observation group and the control group.(2)Changes of hemodynamic indicators: the indicators of CI,SV,LVSWI increased,HR,PCWP,PASP declined,CVP changed little after recanalization,which were significantly obvious between the groups at different times.However,SVRI showed no difference between the groups.(3)Changes of Echocardiography index: the indicators of LVEF,FS increased after recanalization.LVEF and FS of observation group were obvious higher than that of the control group at different times after medication.(4)Changes of plasma level: the plasma BNP and Tnl levels of the two groups after medication were significantly lower than before medication,but the plasma CK-MB level between two groups had no obvious difference.The indicators of ICTP、MMP-9 increased to the maximum at 24 h after recanalization.ICTP、MMP-9 of both groups of control group at 24 h after medication were obviously higher than that of before medication.The rest had no obvious difference during the observation time.(5)Incidences of cardiac arrhythmia and mortality: The incidences of cardiac arrhythmia presented no obvious difference between two groups,and the mortality of observation group were obviously lower than that of the control group at 30 d after medication.Conclusion:(1)The early application of digitalis could improve the left ventricular systolic function.(2)The early application of digitalis could improve collagen metabolism and left ventricular remodeling.(3)The early application of digitalis could effectively played a good safety with decreasing mortality of cardiac arrhythmia.