title: [Effects of pretreatment with recombinant human B-type natriuretic peptide on infarct size in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention].
abstract: OBJECTIVE
  To investigate whether the administration of recombinant human B-type natriuretic peptide (rhBNP) before primary percutaneous coronary intervention (PCI) could further limit the infract size, improve left ventricular function, and alleviate cardiac dilation in patients with acute ST-segment elevation myocardial infarction(STEMI).
  
  
  METHODS
  A total of 93 consecutive patients presenting chest pain within 12 hours from the onset, suspicious of first STEMI located at anterior wall undergoing primary PCI, were eligible for enrollment and randomly assigned to either rhBNP group (rhBNP administration starting at 5 min before PCI, 1.5 µg/kg bolus intravenous injection followed by 0.007 5-0.03 µg·kg(-1)·min(-1) for up to 120 hours, n=48) or nitroglycerin (NIT) group (NIT treatment starting at 5 min before PCI, 10-100 µg/min intravenous infusion for 120 hours, n=45). Primary PCI was performed in both groups using post-conditioning (PC) technique. TIMI flow grade, corrected TIMI frame count, and TIMI myocardial perfusion grade were compared between the two groups at the time of infarct related artery (IRA) re-patency. The levels of serum creatine kinase MB isoenzyme (CK-MB) and troponin I (TnI) were measured. Echocardiography was performed at baseline 7 days and 6 months later.
  
  
  RESULTS
  Baseline characteristics were similar between the two groups. The percentage of TIMI grade 3 and TIMI myocardial perfusion grade 3 after PCI both tended to be higher in rhBNP group than those in NIT group (95.8%(46/48) vs. 86.7%(39/45), P=0.162) and (72.9%(35/48) vs. 62.2%(28/45), P=0.500). The corrected TIMI frame count was significantly decreased in rhBNP group (21.0±8.7 vs. 28.2±14.8, P=0.005). The myocardial infarct size expressed as the AUC of CK-MB ((3 249±1 101) U/L vs. (4 474±1 661)U/L, P=0.010) or AUC of TnI ((3 670±942) µg/L vs. (4 541±1 098) µg/L, P=0.021) was significantly decreased in rhBNP group compared with those in NIT group. At 7 days after primary PCI, the left ventricular ejection fraction (LVEF) tended to be higher (P>0.05), while the E/e' index and wall motion score index (WMSI) ((11.95±3.31 vs. 14.60±4.09, P=0.030) and (1.74±0.17 vs. 2.40±0.55, P<0.001)) were significantly improved in rhBNP group compared with those in NIT group. BNP level was also significantly lower in rhBNP group compared that in NIT group ((68.3±37.8) ng/L vs. (129.4±64.4) ng/L, P<0.001). During 6-month follow-up, LVEF and WMSI were significantly improved in rhBNP group compared those in NIT group(51.7%±12.7% vs. 46.9%±9.6%, P=0.024 and 1.69±0.35 vs. 1.92±0.47, P=0.020).
  
  
  CONCLUSIONS
  Administration of rhBNP before PCI with post-conditioning procedure can further improve myocardial perfusion, limit myocardial infarct size, ameliorate cardiac dysfunction and postpone left ventricular early-stage and long-term remodeling in STEMI patients undergoing primary PCI.
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; Email: shql@medmail.com.cn.
authors.forename: Shiqiang
authors.initials: S
authors.lastname: Li
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fu
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Yuhan
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Yanbo
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Weili
authors.initials: W
authors.lastname: Wu
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Xinshun
authors.initials: X
authors.lastname: Gu
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Guozhen
authors.initials: G
authors.lastname: Hao
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Weize
authors.initials: W
authors.lastname: Fan
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Miao
authors.affiliation: Cardiology Department of the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Yunfa
authors.initials: Y
authors.lastname: Jiang
mesh_terms: D000208:Acute Disease; D052279:Creatine Kinase, MB Form; D004452:Echocardiography; D006801:Humans; D009203:Myocardial Infarction; D020097:Natriuretic Peptide, Brain; D062645:Percutaneous Coronary Intervention; D019210:Troponin I; D016277:Ventricular Function, Left
chemical_list: D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form