| Objective: To explore the clinical effects of L-carnitine in patients withacute ST segment elevation myocardial infarction(STEMI)undergoing primarypercutaneous coronary intervention(pPCI)by analysing the peak value ofcardiac enzymes, the time to the peak value of cardiac enzymes, myocardialperfusion, heart function and the incidence of major adverse cardiacevents(MACE) in patients with acute STEMI undergoing pPCI.Methods: From May2010to October2011,87patients diagnosed asacute STEMI and prepared for pPCI within12hours from onset of symptomswere enrolled into this study,(59men and28women, average age53.98±9.91years old). All the patients were diagnosed according to the criteria ofESC/ACC/AHA/WHF for acute STEMI together, meanwhile underwent pPCIwithin12hours. Exclusion standards were as follows:①the history of oldmyocardial infarction, PCI, coronary artery bypass grafting (CABG);②acutenon-ST segment elevation myocardial infarction;③serious valvular heartdisease, aortic dissection, hypertrophic cardiomyopathy and acute pericarditis;④mechanical complications of myocardial infarction or cardiogenic shock;⑤serious liver or kidney damage, serious infection, coagulation dysfunction,tumour, hemorrhagic diseases, autoimmune diseases, connective tissuediseases;⑥more then12hours from the onset of chest pain;⑦the writteninformed consents couldn't be obtained from patients. The patients wererandomly divided into the L-carnitine(45cases) and the control group (42cases). A dose of300mg aspirin and300mg clopidogrel were administeredimmediately before PCI to all patients, then CAG was performed and PCI wasimplemented for IRA, tirofiban administration was under the discretion ofcoronary blood flow. Patients in L-carnitine group were assigned to the dosage of L-carnitine(Italy sigma-tau Corporation)6g into5%glucose solution250ml(or normal saline)intravenouly after PCI, immediately, and followwedby6g per day intravenously(3hours)for the14days on the basis ofconventional drug guideline on STEMI. Simultaneously, the control groupwere assigned to the equivalent dosage of saline intravenously. The basicclinical date of all patients were collected in detail, such as age, sex, high riskfactors, Killp classification, pre-infarction angina, infarction location, the timefrom onset to revascularization, thrombolysis in myocardialinfarction(TIMI)grading after PCI and TIMI myocardial perfusion grading(TMPG)after PCI, Creatine kinase isoenzyme (CK-MB) and Troponin (CTNI)concentration were recorded separately before PCI, and6,12,18,24,36,48hours after PCI, in order to observe the peak value of cardiac enzymes and thetime to the peak value of cardiac enzymes in two groups, myocardial perfusionwas observed at14days after PCI by means of myocardial perfusion SPECT,left ventricular end diastolic volume(LVEDV), left ventricular end systolicvolume(LVESV), left ventricular ejection fraction(LVEF) were recorded at1week and3months after pPCI in order to assess heart function, the incidenceof MACE (including cardiac deaths, severe heart failure, nonfatalremyocardial infarction, malignant arrhythmias, revascularization of targetvessel)was observed during their hospitalization. SPSS13.0software was usedfor stastical analysis and P <0.05was regarded as a significant difference.Results:1There were no significant difference between two groups in baseline data,such as sex, age, high risk factors(diabetes, hypertension, smoking,dyslipidemia), Killp classification, pre-infarction angina, infarctionlocation, the time from onset to revascularization, TIMI grading andTMPG after PCI, the use of tirofiban.(P>0.05).2The rate of rest myocardial perfusion in L-carnitine group was higher thanthat in the control group at14days after PCI, and there was significantdifference between two groups[(83.44±4.12)%vs.(80.79±4.40)%, P<0.05].3There was no significant difference in the level of CK-MB and CTNI between the L-carnitine group and the control group beforePCI(94.44±21.70vs.101.86±20.07;9.14±4.47vs.9.36±4.24, all P>0.05).The peak value of CK-MB decreased significantly and the time to the peakvalue of CK-MB appeared earlier in L-carnitine group and there wassignificant difference between the L-carnitine group and the controlgroup(179.53±44.78vs.206.64±52.20,11.67±3.51vs.13.36±3.21respectively, all P<0.05. The peak value of CTNI decreased significantlyand the time to the peak value of CTNI appeared earlier in the L-carnitinegroup and there was significant difference between the L-carnitine groupand the control group(18.80±5.02vs.20.92±4.92,10.76±2.82vs.12.26±3.04respectively, all P<0.05).4At1week after pPCI, the result of Echocardiography was that, comparedto the control group, LVEDV(128.73±36.04ml/m2vs.130.76±32.28ml/m2), LVESV(61.36±17.12ml/m2vs.62.26±22.04ml/m2)were lower andLVEF(53.27±7.08%vs.52.24±7.00%)was higher in the L-carnitine group,but there was no significant difference between two groups(P>0.05). After3-month follow-up, compared to the control group, the result ofechocardiography was that LVEDV(110.17±21.97ml/m2vs.121.33±27.93ml/m2), LVESV(46.09±12.63ml/m2vs.51.14±9.01ml/m2)were lowerand LVEF(59.60±9.31%vs.55.38±8.81%)was higher in the L-carnitinegroup,and all had significantly difference(P＜0.05).5Cardiac deaths, nonfatal remyocardial infarction and revascularization oftarget vessel did not happened in two groups during their hospitalization.The incidence of malignant arrhythmias and severe heart failure in theL-carnitine group was lower than that in the control group(4.44%vs.9.52%,2.22%vs.11.90%, all P>0.05), and all had not significantlydifference, but the incidence of all MACE was lower than that in thecontrol group, and it had significantly difference(6.67%vs.21.42%, P＜0.05).Conclusion:1L-carnitine can improve the level of myocardial perfusion in patients with acute STEMI undergoing pPCI.2L-carnitine can decrease the myocardial infarct size in patients with acuteSTEMI undergoing pPCI.3L-carnitine can improve heart function, restrain left ventricular remodelingand improve LVEF in patients with acute STEMI undergoing pPCI.4L-carnitine can reduce the incidence of MACE and improve short-termoutcomes in patients with acute STEMI undergoing pPCI during thehospitalization. |
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