Objectives This research was designed for acute myocardial infarction patients with heart failure and mild renal insufficiency after pPCI, using recombinant human brain natriuretic peptide (rhBNP) contrasted with nitroglycerin (NIT), observe the changes of patients’ renal function, to explore the safety effect about rhBNP in renal function.
Methods Selected patients from June 2010 to February 2012 hospitalised in cardiology department of The Second Hospital of Hebei Medical University, suffered from acute myocardial infarction in 24 hours, simultaneously with heart failure and mild renal insufficiency, a total of 64 cases, 46 cases were male, mean age was 60.95 ± 8.07 years. All patients randomly divided into two groups, the rhBNP (recombinant human brain natriuretic peptide) group and the NIT (nitroglycerin) group. There are 30 cases in the rhBNP group and other 34 cases in the NIT group. The rhBNP group immediately given rhBNP, intravenous the loading dose of 1.5 μg/kg, then intravenous at the starting dose of 0.0075 μg/kg/min, adjusted the maintaining dose range from 0.0075 μg/kg/min to 0.020 μg/kg/min. The NIT group intravenous of introglycerin, start at the dose of 20 μg/min, then carefully adjusted the dose range from 10 μg/min to 100 μg/min,both two groups should close monitoring by experience physicians. All cases underwent emergency coronary artery angiography and implanted metal stent. All patients’ relevant index should be monitored, Including serum creatinine (Scr) and calculation of creatinine clearance rate (Ccr), cystatinC (CysC), β2-microglobulin (β2-MG) changes. Monitoring these indexes both in baseline, and 6 hours, 24 hours, 48 hours, 72 hours after the PCI. Observe the incidence of MACE events of the two groups, the postoperative contrast induced nephropathy incidence.
Results 1. Compared with the two group, there were no significant difference in gender, age, weight, diabetes and hypertension incidence,the dose of contrast agent using, the location and in quantity of coronary artery lesion.
2. There were no significant differences between rhBNP group and NIT group in values of postoperative serum creatinine. And the NIT group value increased more. There also no significant difference between two groups in creatinine clearance rate
About the cystatin C level (mg/L), the peak level of both two groups appeared at 24 hours after PCI, and latter began to fall. There were no significant statistically difference between the two groups in 6,24,48 hours after PCI, but at 72 hours value compare, there were differences. The value in rhBNP group fall down better than the NIT group (N = 0.018). Had statistical significance.
No significant differences were found in β2-microgloblin levels and the urine specific gravity of the two groups.
3. There were no significant difference between two groups in MACE. There were 3 cases occur CIN in the rhBNP group (10.00%), and there were 4 cases of CIN in NIT group (11.76%), No significant difference have found in two groups (P = 0.821).
Conclusions 1. Compared with the NIT group, the use of rhBNP in acute myocardial infarction complicated by heart failure and mild renal insufficiency patients, didn’t lead to serum creatinine elevated significantly, and didn’t deteriorated other renal function observations. The use of rhBNP is safe.