Effect Of Intra-aortic Ballon Pump Started At Different Time On Renal Function In Patients With Acute Myocardial Infarction Complicated With Pump Failure

Objective:To observe the effect of intracoronary balloon pump(IABP)on hemodynamics,renal function and prognosis of patients with acute myocardial infarction(AMI)combined with pump failure,to investigate the best time in acute myocardial infarction complicated with pump failure patients treated by IABP,provide clinical treatment for patients with acute myocardial infarction complicated with pump failure.Methods:From December 2014 to January 2017,selected from hospitalized patients at human provincial people's hospital who were diagnosed as AMI complicated with pump failure.All patients underwent emergency percutaneous coronary intervention(PCI).According to the timing of IABP implantation all patients were divided into two groups:immediate group were implanted IABP when diagnosed as AMI combined with pump failure,the delayed group was treated with positive drugs therapy after emergency PCI,there were still hemodynamic disorders,systolic blood pressure less than 90mmHg,and then underwent IABP surgery.The hemodynamics(eg,mean arterial pressure,heart rate,and urine output)at 7 days after admission were compared between the two groups.Creatinine(Cr),cystatin C(CysC),neutrophil gelatinase-related lipid transport protein(NGAL),and renal injury factor-1(KIM-1)were used to evaluate renal function,detection the levels of SCr,NGAL and Cys-C urine KIM-1 were measured at 2h,6h,12h,24h and 48h after admission.The peak levels of renal function were compared between the two groups.Comparison of the two groups of catecholamines,diuretics duration time,hospitalization time,the incidence of acute kidney injury(AKI)and 90-day survival rate.Results:1.After admission seven days,the immediate IABP group(n=34)and the delayed group(n=32)mean arterial pressure,heart rate,urine output were(87.5±14.5mmHg,77.4±12.8mmHg),(82.3±17.2 bpm,92.9±16.2 bpm),(52.8±8.4 ml/h,41.9±7.2 ml/h),the difference between the two groups was statistically significant(P<0.05).2.The peak value of serum Cr,serum Cys-C,serum NGAL and urinary KIM-1 in the immediate group(n=34)and the delayed group(n=32)were(111.6±28.1umol/L,129.6±29.8umol/L),(1.31±0.32mg/L,2.48±0.42mg/L),(143.3±23.1ng/ml,181.4±30.2ng/ml),(54.56±6.18ng/L,63.61±10.39ng/L),the difference between the two groups was statistically significant(P<0.05).3.The time of use of catecholamine drugs,diuretics and hospitalization in the immediate group(n=34)and the delayed group(n=32)were(3.3±0.5d,6.1±1.4d),(4.6±0.7d,8.3±1.9d),(13.7±4.1d,16.6±5.4d),the difference between the two groups was statistically significant(P<0.05).The incidence of AKI during hospitalization and follow-up 90-day survival rate in the immediate group(n=34)and delayed group(n=32)were(11.8%,34.4%),(79.4%,56.3%),the difference between the two groups was statistically significant(P<0.05).Conclusion:1.Early implantation of IABP helps stabilize the hemodynamic status of patients with acute myocardial infarction complicated with pump failure.2.Early implantation of IABP can reduce the levels of serum SCr,Cys-C,NGAL and urinary KIM-1 in patients with acute myocardial infarction complicated with pump failure,effectively reducing the damage of kidney.3.Immediate use of IABP after acute myocardial infarction combined with pump failure can play a more effective role in reducing the use of catecholamine drugs,reducing the incidence of acute renal injury and improving the survival rate of patients.