Clinical Research On Myocardial Cytoprotection Of Tong-guan Capsules During Percutaneous Coronary Intervention

BackgroundMyocardial injury is a common complications during Percutaneous Coronary Intervention(PCI) for myocardial revascularization. In recent years an increasing number of study found that mortality and recurrence rate of cardiac events increased in patients that markers of myocardial injury elevation after percutaneous coronary intervention, suggesting a poor prognosis. But, there are many limitations of the current studies on myocardial cytoprotection during PCI for myocardial revascularization. It is the Weak links of the current study on percutaneous coronary intervention perioperative. There is a significant effect in Traditional Chinese Medicine (TCM) treatment of coronary heart disease. However, compared with the constantly improving diagnosis and treatment system of acute conoary syndrome under the guidance of the Evidence-based medicine, Traditional Chinese Medicine develop much slowly. People think it may have great potential for development of traditional Chinese medicine treatment. We can choose the weak links of the current study on the percutaneous coronary intervention perioperative, such as myocardial cytoprotection during percutaneous coronary intervention, as a crossing of traditional Chinese medicine and western medicine.After a series of studies have proven that, Tong-guan Capsules, which is a proprietary Chinese medicine with effect of Yi-Qi-Huo-Xue(Terminology of TCM) , Can play extensive clinical role during percutaneous coronary intervention for myocardial revascularization. It can improve various biochemical markers, cardiac function and quality of life in patients that have been treat by percutaneous coronary intervention, which clearly prompts us that it is a possibility that Tong-guan Capsules may play the role of myocardial cytoprotection during PCI. ObjectiveThe objective of this research is to study the myocardial cytoprotection of Tong-guan Capsules during percutaneous coronary intervention for myocardial revascularization. For in-depth study, it is also the objective that to study the TCM Differential Treatment on PCI perioperative.MethodsAccording to diagnosis standard and bring-into standard, 30 patients that hospitalized to accept percutaneous coronary intervention myocardial revascularization in the ICU and Heart Center of TCM Hospital of Guangdong Province were recorded finally. They were randomly divided into two groups for compare, as 18 cases of the experimental group and 12 cases of the control group. Patients belong to the experimental group accepted the treatment with Tong-guan Capsules before percutaneous coronary intervention, while the ones of the control group accepted the treatment without Tong-guan Capsules to make different. To record the change of Intracoronary ECG(IC-ECG) during PCI operation, and to test the level of myocardial injury markers at the time of 3 hours and 18 hours after percutaneous coronary intervention for each patient. To compare difference between the two groups for statistically calculation.ResultThe parameters of the two groups before percutaneous coronary intervention between the comparison group was not significant (P> 0.05). The parameters for the operation of percutaneous coronary intervention between the comparison group was not significant (P> 0.05) either. The largest ST-segment elevation margin recorded by Intracoronary ECG of the experimental group was clearly lower than that of the control group, and the difference was significant (P=0. 04) . T-wave maximum height of the absolute value after percutaneous coronary intervention recorded by Intracoronary ECG of the experimental group was clearly lower than that of the control group, and the difference was significant (P=0.04) . In that part of myocardial injury markers, all the levels of troponin I (cTNI) , creatine kinase-MB (CKMB), creatine kinase (CK) , lactate dehydrogenase ( LDH ) and aspartate aminotransferase (AST) of the experimental group, either at the time of 3 hours after PCI operation or at the time of 18 hours after operation, were lower than those of the control group, with a significant difference in creatine kinase-MB level at the time of 18 hours after operation (P=0. 03) . But the differences between the comparison group for the levels of remaining myocardial injury markers were not significant (P>0.05). Levels of three myocardial injury markers as troponin I, creatine kinase-MB, creatine kinase had a trend of increased (the differences between the Levels before PCI operation and after PCI were not significant, with P>0. 05), while changes in the experimental group were smooth and without increasing trend.Conclusion1. In the treatment of Tong-guan Capsules for more than a day (Sig: 3 pills po tid) before PCI, the extent of myocardial injury during myocardial revascularization could be reduced clearly. The effect of Yi-Qi-Huo-Xue in Tong-guan Capsules plays the role of myocardial cytoprotection during percutaneous coronary intervention.2. This reseach has choosen myocardial cytoprotection during percutaneous coronary intervention for the entry point to integrate the traditional Chinese medicine and western medicine. According to that the syndrome-types features in traditional Chinese Medicine on PCI perioperative mainly is the syndrome of Qi-Xu-Xue-Yu in TCM, the reseach confirmed the preliminary conclusion that there is myocardial cytoprotection with the traditional Chinese medicine differential treatment on percutaneous coronary intervention perioperative. This reseach had maken a mild exploratory study on the way to integrate the traditional Chinese medicine and western medicine for treatment to coronary heart disease.