| Objective Acute ST-segment elevation myocardial infarction is one of the most common causes of high morbidity and mortality in the world due to the morbidity and complications associated with adverse sequelae.When the occurrence of acute myocardial infarction,followed by the loss of myocardial function,the early heart will make structural change to maintain the original cardiac output.The physical response of the heart to these reactions is called remodeling.This remodeling begins as soon as acute myocardial infarction happens and it may be associated with the patients for a lifetime.Although this adaptive change may be beneficial and compensatory in the short term,it will eventually lead to congestive heart failure over time.When the myocardial cells stretch in patients with acute ST-segment elevation myocardial infarction,with the absence of ventricular wall stress,a protein is released from the left ventricle as response to volume expansion and pressure overload,named B-type natriuretic peptide(BNP).BNP can be used independently as a marker of whole blood to identify left ventricular insufficiency.BNP is decomposed into Amino terminal b-type natriuretic peptide precursor(NT-pro BNP)by the action of lyases.Both of BNP and NT-pro BNP have the same effect,but NT-pro BNP is more stable,which is more conductive to laboratory operation.Therefore,the aim of this study is to analyze the changes of B-type natriuretic peptides before and after primary percutaneous coronary intervention(PPCI)in patients with different time intervals of symptom onset to infarct-related artery recanalization to study the effection of different time intervals on left heart function.Methods Select patients who are diagnosied of acute ST-elevation myocardial infarction for the first time in Da Tong NO.3 Hospital from March 2017 to June 2017 and all the patients are treated with PPCI.Exclusion criteria: recurrent of acute myocardial infarction,left ventricular hypertrophy,severe liver and kidney dysfunction,patients with severe anemia,respiratory failure,cardiomyopathy,valvular disease,and multivessels are completely blocked.According to the different time intervals between the onset of symptoms and infarct-related vascular recanalization,78 patients with a time interval of ≤3 hours were collected and randomly selected 20 patients as group A.61 patients with a time interval of 3 to 6 hours were randomly selected.Twenty patients were selected as group B.81 patients were collected at intervals of 6to 12 hours,and 20 patients were randomly selected as group C.Test blood NT-pro BNP of each group of patients before PPCI and 7 days and 15 days after operation.Observe whether they suffer from major adverse cardiovascular events(MACE)in 6 months after operation compassing recurrent ischemic chest pain,reimplantation of target lesions,in-stent stenosis,and non-fatal myocardial infarction and other adverse cardiovascular events.SPSS 21.0 software was used to perform statistical analysis on all information content.Measurement data uses mean ± standard deviation(X ±S)to represent.Normal distribution uses the t test;categorical variables uses chi-square(X2)test.P <0.05 is considered statistically significant.Results(1)The preoperative general and past history of the three groups have no statistical significance in gender,age,history of hypertension,history of type 2diabetes,history of hyperlipidemia,smoking history,and myocardial infarction.Each patient received aspirin enteric-coated tablets and clopidogrel bisulphate oral symptomatic treatment before the PPCI.After the operation,continuous aspirin enteric-coated tablets and clopidogrel bisulfate were administered.(2)There was no significant difference in NT-pro BNP levels among the three groups before PPCI(P >0.05).(3)7 days after the operation,NT-pro BNP levels in all three groups decreased,and group A was significantly lower than group B and C.The difference has ststistical significance.Group B was significantly lower than group C.(4)15 days after the operation,NT-pro BNP levels decreased in all three groups,and group A was significantly lower than group B and C.Group B was significantly lower than group C.(5)In group A,compared with preoperation,7 days after PPCI the difference of patients’ NT-pro BNP levels was statistically significant(t=19.77,P <0.05),15 days after the operation we got t=20.35,P <0.05,compared with 7 days after PPCI,meaning the difference was statistically significant.(6)In the group B,compared with preoperative,7 days after PCI the difference of patients’ NT-PROBNP levels was statistically significant(t=21.76,P <0.05),15 days after the operation we got t=23.48,P<0.05,compared with 7 days after PPCI,meaning the difference was statistically significant.(7)In the group C,compared with preoperative,7 days after PCI the difference of patients’ NT-PROBNP levels was statistically significant(t=29.35,P<0.05),15 days after the operation we got t=25.83,P<0.05,compared with 7 days after PPCI,meaning the difference was statistically significant.(8)No recurrent acute myocardial infarction and acute heart failure occurred in the hospital and out of the hospital after follow-up within 6 months.Among the patients in group A,2(10%)patients had symptoms of angina.3(15%)patients in group B had symptoms of angina outside the hospital,and 8 patients(40%)in group C had symptoms of angina outside the hospital.Conclusion(1)For patients with acute ST-segment elevation myocardial infarction,the key of the treatment is to do our utmost effort to shorten the time interval between symptom onset and mechanical reperfusion.Open early infarction-related artery and restore myocardial forward flow as soon as possible.It has significance in preventing ventricular remodeling,improving left ventricular function and reducing poor prognosis;(2)B-type natriuretic peptide can be independently used as a whole blood index for judging the degree of left ventricular dysfunction and the degree of recovery of left heart function after treatment of acute myocardial infarction,which is critical for patients who is in the condition that is not suitable for out-going examination,or there is no echocardiography beside the bed. |
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