| Objective: To observe the clinical efficacy of recombinant human brain natriuretic peptide combined with Sacubitril/valsartan in patients with acute anterior ST segment elevation myocardial infarction,and to provide more clinical evidence for the clinical application of rh-BNP combined with Sacubitril/valsartan in patients with myocardial infarction.Methods: Patients with acute anterior STEMI who received emergency percutaneous coronary intervention in the Fifth Department of Cardiology,Second Hospital of Hebei Medical University from January 1,2019 to December 31,2020 were enrolled。The patients were randomly divided into two groups: the experimental group,treated with rh-BNP combined with Sacubitril/valsartan on the basis of conventional drug treatment,and the control group,treated with rh-BNP combined with angiotensin converting enzyme inhibitors on the basis of conventional drug treatment.The basic data of admission,the date of interventional operation,the date of left ventricular ejection fraction and left ventricular end diastolic diameter were collected.The changes of plasma N-terminal pro brain natriuretic peptide concentration,heart rate and systolic blood pressure during hospitalization and discharge were analyzed.The adverse reactions and major adverse cardiovascular events during hospitalization and follow-up were observed and recorded.After collecting the above data,spss20.0 software was used for statistical analysis.P< 0.05 showed that the difference was statistically significant.Results: A total of 80 patients were selected,including 40 patients in the test group and 40 patients in the control group.There was no significant difference between the two groups in sex,age,kidney function index,time of first medical contact,smoking history,drinking history,hypertension,diabetes,stroke,Killip grade,combination of drugs,interventional operation,etc.,(P>0.05).The serum NT-pro BNP concentration on admission between the test group and the control group was(148.95 ± 22.20 VS.141.38 ±21.77,P>0.05),and there was no significant difference between the two groups.The serum NT pro BNP levels of the two groups were significantly higher on the 2nd day,7th day and 1 month after discharge than those at the moment of admission(148.95 ± 22.20 VS.1812.73±328.21,P<0.05;148.95 ± 22.20 VS.915.90±255.91,P<0.05;148.95 ± 22.20 VS.178.32±50.48,P<0.05;141.38±21.77 VS.2543.00±382.07,P<0.05;141.38±21.77 VS.1260.70±280.01,P<0.05;141.38±21.77 VS.224.36±69.59,P<0.05),The difference was statistically significant.The serum NT-pro BNP levels of the patients in the experimental group were significantly lower than those in the control group on the 2nd day,7th day and 1 month after discharge(1812.73±328.21 VS.2543.00 ± 382.07,P<0.05;915.90 ± 255.91 VS.1260.70 ±280.01,P<0.05;178.32±50.48 VS.224.36±69.59,P<0.05),and the difference was statistically significant.There was no significant difference in cardiac function indexes LVEF and LVEDD between the two groups at admission(41.03±3.05 VS.40.95±3.24,P>0.05;54.58±2.09 VS.55.17±2.15,P>0.05).One month after discharge,the cardiac function indexes LVEF and LVEDD in the two groups were both improved,and the difference was statistically significant(41.03±3.05 VS.44.53±3.98,P<0.05;40.95±3.24 VS.42.56±3.18,P<0.05;54.58±2.09 VS.52.49±3.14,P<0.05;55.17±2.15 VS.53.93±3.28,P<0.05)。The improvement in the experimental group was more obvious,and there was significant difference between the two groups(44.53±3.98 VS.42.56 ± 3.18,P<0.05;52.49 ± 3.14 VS.53.93 ± 3.28,P<0.05).There was no significant difference in systolic blood pressure and heart rate between the two groups at admission(108.10±24.63 VS.111.95±21.01,P>0.05;93.50±9.80 VS.92.85±8.75,P>0.05).The systolic blood pressure of the two groups decreased significantly when they were discharged from hospital after treatment,and the difference was statistically significant(108.10 ± 24.63 VS.94.60 ±19.80,P<0.05;111.95±21.01 VS.103.06±16.18,P<0.05).And the degree of decrease in the experimental group was higher than that in the control group,and the difference was statistically significant(94.60 ± 19.80 VS.103.06 ±16.18,P<0.05).After hospitalization,the heart rate of the two groups was lower than that before treatment,and the difference was statistically significant(93.50± 9.80 VS.64.25± 5.65,P<0.05;92.85± 8.75 VS.65.45±6.65,P<0.05).However,there was no significant difference in heart rate between the two groups at discharge(64.25 ± 5.65 VS.65.45 ±6.65,P>0.05).There was no significant difference in adverse reactions such as hypotension,hyperkalemia,angioedema,dry cough and damage of liver and kidney function between the two groups during hospitalization and discharge follow-up.There was no significant difference in MACE events such as cardiovascular death,recurrent myocardial infarction,re-hospitalization of heart failure and bleeding between the two groups,during hospitalization and discharge follow-up.Conclusions: In patients with acute anterior ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention,early application of recombinant human brain natriuretic peptide combined with Sacubitril/valsartan can improve clinical symptoms,inhibit ventricular remodeling,and does not increase the incidence of adverse reactions and cardiovascular events. |
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