| Objective: Application of NT-pro BNP and CAMI-STEMI score to evaluate the therapeutic effect of sacubitril-valsartan in the treatment of patients with acute myocardial infarction complicated with heart failureMethods:Selected 80 patients with acute ST-segment elevation myocardial infarction complicated with heart failure(Killip II-III grade)who were admitted to the Department of Cardiovascular Medicine,Baogang Hospital,Inner Mongolia from June 2020 to November 2021,and were randomly divided into the observation group(Sac/Val group).)and the control group(Val group),each with 40 cases.After admission and treatment,after the patient’s vital signs were stable,the control group was given dual antiplatelet,statins,β-receptor antagonists,furosemide tablets,spironolactone tablets conventional treatment + valsartan 40 mg/time,once a day,Gradually increase to the target dose of 80 mg per time,once a day,and adjust the dose according to the blood pressure;the observation group was given dual antiplatelet,statins,β-receptor antagonists,furosemide tablets,spironolactone tablets conventional treatment + sacubitril and valsartan,for patients who have not taken ACEI or ARB drugs before,take a small dose of 25 mg per time,2 times a day,and adjust the dose according to the patient’s condition to a target dose of 100 mg/time,twice a day,If the patient has taken oral ACEI drugs in the past,they should start taking them after the washout period of 36 hours.If the patient has taken oral ARB drugs in the past,they should start taking them after stopping the drugs.After reaching the target dose,the patients in the two groups continued to take the drug for long time.General clinical data of patients were collected.LVEF,LVESD and LVEDD,which were from Cardiac color ultrasound examination,and NT-pro BNP were recorded 24 hours after admission,1 month after therapy and 3 months after curing in the observation group and Control Group.The CAMI-STEMI scores of two groups were recorded at admission and 1 month after medical treatment.and following up the main adverse cardiovascular events within 3 months of continuous medication.Result:The NT-pro BNP of the two groupsat within 24 hours after admission were(1885.18±479.03pg/m L)and(1720.45±649.69pg/m L),respectively,and the results were not statistically significant(P=0.201).After 1 month of treatment,the result of NT-pro BNP in observation group was 1162.28±307.67pg/m L,which was1338.55±286.50pg/m L in control group,observation group dropped more and the results were statistically significant.After 3 months of treatment,the NT-pro BNP in the observation group(965.62±239.45pg/m L)decreased more significantly than it in the control group(1110.68±339.43pg/m L),and the decrease was more significant after 3 months of treatment.The CAMI-STEMI scores of the two groups at admission were(4.80±1.47points)and(5.10±1.53points),respectively,and the results were not statistically significant(P = 0.375),after 1 month of treatment,the observation group(1.52±0.91points)decreased more significantly than the control group(2.60±1.32分 points).The LVEF at 24 hours after admission in the two groups were(38.32±2.80)% and(37.65±2.87)%,respectively,and the results were not statistically significant(P = 0.290).The LVEF in observation group is(41.85±2.81)% when the patients acceptted treatment for one month,at the same time the control group is(39.28±3.13)%,the comparison had distinctly statistical sense(P<0.001).The result of LVEF in the observation group is(45.95±3.18)% after 3 months of treatment,which increased more greatly than the control group(43.22±3.13)%,and the increase was more significant after 3 months of treatment.The figure of LVESD in the two groups within 24 hours after admission was(42.38±3.24mm)and(42.70±2.47mm),without statistical meaning between the two groups(P=0.601).The LVESD of the observation group is 39.20±2.95 mm when accepting therapy for one month,which decreased more significantly than the control group that the LVESD is 40.65±2.30 mm and accepting the same period of therapy.The result of LVESD in observation group after three months of therapy was 37.62±2.47 mm,while control group was 39.28±2.08 mm,the difference had statistical significance between the two groups(P=0.002).Compared with one month of treatment,the LVESD of treatment for three months had more pronounced dropping.The LVEDD of two groups within 24 hours after admission were(58.28±3.20mm)and(58.72±2.45mm),respectively,without statistical significance(P=0.450).After 1 month of treatment,the LVEDD of the observation group was 54.95±2.48 mm,while the control group was 56.08±2.56 mm,and the observation group reduced more notablly after comparison.Its level in the observation group(51.75±2.99mm)had more significant reduction than the control group(54.02±2.09mm)after 3 months of treatment,and the decline was more obvious after3 months of treatment.The incidence of MACE in the two groups was followed up within 3 months after continuous medication.the total incidence of MACE in the observation group was lower than that in the control group,the result had statistical Sense(P=0.007).Conclusion : Sacubitril-valsartan can improve cardiac function and short-term prognosis in patients with acute myocardial infarction complicated with heart failure,and it is worthy of clinical promotion. |
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