Invest Clin 65(3): 335 - 345, 2024 https://doi.org/10.54817/IC.v65n3a06

Corresponding author: Jing Ma. Department of Cardiovascular Medicine, Affiliated Hospital of Hebei University,

Baoding, China. E-mail: MJ0111MJ@163.com

Benefits of recombinant human brain

natriuretic peptide to improve ventricular

function and hemodynamics in patients

with ST-elevation myocardial infarction.

Dahuan Shi

, Xin Li

, Lantao Yang

, Chunmei Luo

and Jing Ma

Department of Emergency Medicine, Baoding No. 2 Central Hospital, Baoding, China.

Department of Cardiovascular Medicine, Affiliated Hospital of Hebei University,

Baoding, China.

Keywords: ST-segment elevation myocardial infarction; recombinant human brain natri-

uretic peptide; tirofiban; primary percutaneous coronary intervention.

Abstract. This study aimed to assess the impact of recombinant human

brain natriuretic peptide (rh-BNP) on ventricular function and hemodynamics

in post-ST-segment elevation myocardial infarction (STEMI). We compared the

outcomes of 65 STEMI patients treated with rh-BNP to an equal cohort given

tirofiban following percutaneous coronary intervention (PCI). Data collected

pre- and post-intervention included biochemical markers, TIMI (Thrombolysis In

Myocardial Infarction) grade, hemodynamics, thrombotic score (TS), left ven-

tricular ejection fraction (LVEF), high-sensitivity C-reactive protein (CRP) levels,

liver and kidney function, and ECG. The TIMI level (p=0.03), the ratio of TIMI

myocardial perfusion grade III (p=0.04), and the thrombus score (p<0.001) in

the rh-BNP group after the intervention markedly exceeded those in the tirofiban

group. After correction, the TIMI frame count (CTFC) (p=0.02), the incidence

of slow flow (p=0.02), thrombus score (p<0.001), stent length (p=0.02) as well

as times of administration of sodium nitroprusside medication in the rh-BNP

group were markedly below those in the tirofiban group (p=0.01). Creatine ki-

nase (CK) (p<0.001), CK-MB (p=0.01), and N-terminal pro-b-type natriuretic

peptide (NT-proBNP) (p<0.02) in the rh-BNP group were markedly below those

the in tirofiban group 24 hours after intervention; and the sum-STR (p<0.03)

immediately after intervention markedly exceeded that in the tirofiban group.

No significant differences were found in major cardiac adverse events (MACE)

between the treatments. At the 30-day follow-up, rh-BNP showed a more effective

enhancement of blood flow status, with the safety profiles of both treatments be-

ing comparable. The findings suggest that the rh-BNP has significant potential

for treating PPCI-related slow flow.

336 Shi et al.

Investigación Clínica 65(3): 2024

Beneficios del péptido natriurético cerebral humano

recombinante para mejorar la función ventricular

y la hemodinámica en pacientes con infarto de miocardio

con elevación del segmento ST.

Invest Clin 2024; 65 (3): 335 – 345

Palabras clave: infarto de miocardio con elevación del segmento ST; péptido

natriurético recombinante del cerebro humano; tirofibán; intervención

coronaria percutánea primaria.

Resumen. El objetivo de este estudio fue evaluar el impacto del péptido na-

triurético cerebral humano recombinante (rh-BNP) sobre la función ventricular y la

hemodinámica después de un infarto de miocardio con elevación del segmento ST

(STEMI). Comparamos los resultados de 65 pacientes con STEMI tratados con rh-

BNP con un grupo equivalente tratado con tirofiban tras la intervención coronaria

percutánea (PCI). Los datos recopilados antes y después de la intervención inclu-

yeron marcadores bioquímicos, grado TIMI (Trombolisis en infarto del miocardio),

hemodinámica, puntuación trombótica (TS), fracción de eyección del ventrículo iz-

quierdo (LVEF), niveles de proteína C reactiva de alta sensibilidad (CRP), función he-

pática y renal y ECG. El nivel de TIMI (p=0,03), la proporción de grado de perfusión

miocárdica TIMI III (p=0,04) y la puntuación trombótica (p<0,001) en el grupo rh-

BNP después de la intervención superaron significativamente a aquellos en el grupo

de tirofiban. Tras la corrección, el conteo de fotogramas TIMI (CTFC) (p=0,02), la

incidencia de flujo lento (p=0,02), la puntuación trombótica (p<0,001), la longi-

tud del stent (p=0,02) así como las veces de administración de la medicación de

nitroprusiato de sodio en el grupo rh-BNP fueron notablemente inferiores a los del

grupo de tirofiban (p=0,01). La CK (p<0,001), la CK-MB (p=0,01) y la NT-proBNP

(p<0,02) en el grupo rh-BNP fueron significativamente inferiores a los del grupo de

tirofiban 24 horas después de la intervención, y la sum- ST-segment resolution (STR)

(p<0,03), inmediatamente después de la intervención superó significativamente a

la del grupo de tirofiban. No se encontraron diferencias significativas en los eventos

adversos cardiacos mayores (MACE) entre los tratamientos. En el seguimiento de

30 días, el rh-BNP mostró una mejora más efectiva del estado del flujo sanguíneo,

siendo los perfiles de seguridad de ambos tratamientos comparables. Los hallazgos

sugieren que el rh-BNP tiene un potencial significativo para tratar el flujo lento re-

lacionado con PPCI.

Received: 20-08-2023 Accepted: 11-02-2024

INTRODUCTION

ST-segment elevation myocardial in-

farction (STEMI) is a severe form of heart

attack characterized by a prolonged period

of blocked blood supply that affects a large

area of the heart muscle

. The mean age of

a first MI is 65.1 for men, while for women, it

is 72. An ST-elevation myocardial infarction

affects around 38% of patients with acute

coronary syndrome when they arrive at the

hospital

Benefits of natriuretic peptide in ST-segment elevation myocardial infarction 337

Vol. 65(3): 335 - 345, 2024

STEMI is commonly caused by the rup-

ture of an atherosclerotic plaque in a cor-

onary artery, leading to the formation of a

blood clot that completely blocks the artery

and interrupts blood flow to the heart mus-

cle. This results in myocardial ischemia and,

if not promptly treated, irreversible damage

to the heart muscle

1,2

The symptoms of STEMI can include

chest pain or discomfort, shortness of

breath, nausea, lightheadedness, and pain or

discomfort in other areas of the upper body,

such as the arms, back, neck, jaw, or stom-

ach

Diagnosis of STEMI is primarily based

on the clinical presentation, ECG findings,

and the elevation of cardiac biomarkers. An

ECG demonstrating ST-segment elevation

is considered diagnostic, particularly when

complemented by symptoms indicative of

ischemia. Furthermore, cardiac enzymes

such as troponins are utilized to confirm

myocardial damage

1,4

Treatment of STEMI focuses on the

timely restoration of coronary blood flow,

typically achieved through reperfusion ther-

apies such as percutaneous coronary inter-

vention (PCI) or thrombolytic therapy

. Ad-

juvant therapies include antiplatelet agents,

anticoagulants, beta-blockers, and angioten-

sin-converting enzyme inhibitors to reduce

myocardial oxygen demand and prevent fur-

ther thrombus formation

6,7

In this context, recombinant human

brain natriuretic peptide (rhBNP) thera-

py emerges as a novel adjunct in manag-

ing STEMI. rhBNP, a synthetic form of the

naturally occurring brain natriuretic pep-

tide, has shown promise in improving ven-

tricular function and hemodynamics

. Its

mechanisms of action include vasodilation,

natriuresis, and the inhibition of the renin-

angiotensin-aldosterone system, which col-

lectively contribute to reduced cardiac load

and improved myocardial recovery

. Ac-

cording to a study by Zhou et al.

, rhBNP

has shown promise in improving ventricu-

lar function and hemodynamics in patients

with end-stage renal disease and type 4 car-

diorenal syndrome. Another study by Liang

et al. suggests that rhBNP combined with

catheter-directed therapy may improve right

ventricular dysfunction and stabilize hemo-

dynamics in patients with acute pulmonary

embolism

Given the high stakes of STEMI man-

agement and the potential impact on pa-

tient outcomes, a comprehensive evaluation

of rhBNP’s efficacy and safety is warranted.

Since limited studies have been conducted

in this field, especially in the Middle East,

this study was essential to elucidate the ef-

fect of the therapeutic effect of recombinant

human brain natriuretic peptide in patients

with myocardial infarction by increasing the

ST piece.

MATERIALS AND METHODS

General information

The research is a retrospective study

using case data. The criteria for selecting

patients in this study were as follows: the di-

agnosis of STEMI symptoms following views

of the “STEMI Diagnosis and Treatment

Guidelines”

; patients received PCI treat-

ment within 12 h after admission; treatment

with tirofiban (TIF) or rh-BNP after PCI; no

allergic reactions were observed after treat-

ment with TIF or rh-BNP; did not receive

intravenous thrombolysis treatment before

PCI; Killip level exceeds that of Grade III or

cardiogenic shock patients. Exclusion crite-

ria: patients with comorbidities of organ and

tissue diseases such as brain, heart, kidney,

and liver; patients with severe aortic steno-

sis; patients with mental or other cognitive

impairments or who refuse to cooperate with

the experiment; patients with pulmonary hy-

pertension caused by pulmonary heart dis-

ease or other reasons; patients with a history

of MI, valvular heart disease, dilated cardio-

myopathy, HF, hypertrophic cardiomyopathy,

or other general diseases. Given the above

standards, this study collected the medical

history information of 142 STEMI patients

338 Shi et al.

Investigación Clínica 65(3): 2024

admitted to our hospital from June 2021 to

June 2023, with 130 participants included

in the experimental study. In the queue,

65 patients received treatments with TIF,

while the remaining cases received treat-

ments with rh-BNP. All sufferers had clinical

and pathological features taken and signed

an informed consent form to use this infor-

mation. This research was approved by the

Ethics Committee of the Medical Center to

collect relevant information from sufferers

(approval number: MEC-2021-06). All work

was carried out following the provisions of

the Declaration of Helsinki. The research

process is demonstrated in Fig. 1.

Treatment strategies

All patients took 300 mg aspirin orally,

clopidogrel 300 mg/ticagrelor 180 mg, and in-

travenous heparin 5000 IU at admission. Coro-

nary artery angiography (CAG) was carried out

before intervention to determine the quantity

of the pathological branches, for patients who

received treatments with rh-BNP, 5 mg of medi-

cation was injected intravascularly during the

intervention period, followed by implantation

of a stent and re-administration of 5 mg of rh-

BNP. If the symptoms of slow BF persisted, they

were given a last 5 mg dose of rh-BNP. Sufferers

who received treatments with TIF were slowly

injected 5 mg/kg through the CA during the

intervention period. After the stent implanta-

tion, 5 mg/kg TIF was administered via CA

again. 3 mg/kg TIF was injected through the

CA for sufferers with slow BF symptoms. After

24 hours of intervention, all patients were giv-

en aspirin 100 mg, clopidogrel 75 mg/ticagre-

lor 90 mg and heparin 5000 IU for 5-7 days.

Patients were followed up for 30 days after dis-

charge, and MACE (Major Adverse Cardiovas-

cular Events) were recorded.

Measurement of treating outcomes

The myocardial infarction thrombolysis

(TMI) classification, hemodynamic param-

eters, thrombotic score (TS)

, left ventricu-

lar ejection fraction (LVEF), CRP level, uric

acid, liver and kidney functions, electrocar-

diogram (ECG), echocardiography and oth-

er information of patients before and after

the intervention were collected to compare

differences in the therapeutic effects (treat-

ment efficacy) and SE of the two treatment

methods.

Statistical analysis

Relevant analysis was conducted us-

ing the SPSS version 19.0 software (IBM

Fig. 1. Research Process.

Benefits of natriuretic peptide in ST-segment elevation myocardial infarction 339

Vol. 65(3): 335 - 345, 2024

Armonk, NY). Continuous data was denoted

by mean ± standard deviation (SD). The

number of cases denotes classified data. The

Student test was used to compare the dif-

ferences between consecutive data sets. Chi-

square and Fisher’s exact tests were used to

determine whether there are differences be-

tween different categories of index groups.

p<0.05 is statistically significant.

RESULTS

Patient baseline characteristics

The analysis of baseline data among the

sufferers participating in this experiment

did not demonstrate significant differences

(SD) in preoperative age, body mass index

(BMI), and other indicators. Table 1 demon-

strates the details.

No statistically significant differences

were among the sufferers participating in

this experiment in combined medication

(Table 2).

Intervention Information

Table 3 indicates no differences in the

number of branches, number of stents, and

score of thrombus before the intervention,

systolic blood pressure, and other relevant

respects. However, after the intervention,

the TMI changes in thrombus score levels

in the rh-BNP group and other relevant as-

pects dramatically exceeded those in the

TIF group (Table 3). On the other hand, the

TMI Frame Count (CTFC), slow flow (SF) in-

cidence, post-intervention thrombus score,

stent length, and sodium nitroprusside ad-

ministration times after correction were dra-

matically ´lower in the TIFgroup (Table 3).

The effect of rh-BNP or TIF

on the treating outcomes of PCI

Twenty-four hours after PCI interven-

tion, creatine kinase (CK), creatine kinase

isozyme (CKMB), and the amino-terminal

fraction of B-type natriuretic peptide (NT

pro-BNP) in the rh BNP group were dramati-

Table 1

Baseline Characteristics.

Characteristic rh-BNP(n=65) TIF(n=65) t/χ

Age (years) 60.19±10.02 58.96±10.14 1.462 0.09

Gender (male, %) 47(72.3) 51(78.5) -0.613 0.36

BMI(kg/m

) 25.94±3.54 25.44±3.29 0.837 0.50

Time before balloon dilation(min) 227.98±68.52 232.19±86.43 -0.388 0.63

Killip classification

Level 1 (n, %) 61(93.8) 60(92.3) 0.117 0.69

Level 2 (n, %) 4(6.2) 5(7.7)

Smoke (n,%) 41(63.1) 40(61.5) 0.035 0.85

Drink (n,%) 24(36.9) 14(21.5) 3.710 0.06

Hypertension (n, %) 41(63.1) 47(72.3) 1.258 0.27

Level 1 (n, %) 8(12.3) 7(10.8)

Level 2 (n, %) 16(24.6) 14(21.5) 0.286 0.85

Level 3 (n, %) 17(26.2) 19(29.2)

Diabetes (n, %) 18(27.7) 21(32.3) 0.328 0.56

Cerebral Infarction (n, %) 8(12.3) 11(16.9) 0.525 0.49

t: t-test; χ

: Chi-squared test; BMI: body mass index; rh-BNP: B-type recombinant human brain peptide.

TIF: tirofiban.

340 Shi et al.

Investigación Clínica 65(3): 2024

cally lower than in the TIF group. The LEVF

changes in the rh-BNP group (RBG) dra-

matically exceeded those in the TIF group.

(Table 4).

However, there were no statistical dif-

ferences among the sufferers participat-

ing in this experiment in CK (p=0.13) and

CKMB (p=0.18) at the peak recording time

points. The sum STR in the RBG also mark-

edly exceeded that in the TIF group immedi-

ately after intervention (Table 5), and there

were no differences in sum STR two hours

after the intervention (Table 5).

Major Adverse Cardiovascular Events

(MACE)

The incidence of angina and HF in the

RBG was dramatically lower than in the TIF

group (Table 6). On the other hand, in terms

of CA occlusion microbleeds, the incidence

of TMI microbleeds, the overall utilization of

streptokinase, tissue type plasmin activator,

and other relevant aspects in the RBG mark-

edly exceeded those in the TIF group (Table

6). Both groups of patients did not experi-

ence MI or other severe side effects (Table 6).

Discharge follow-up

After discharge, there was no follow-up

loss for 30 days. According to the informa-

tion shown in Table 7, there were no differ-

ences in physiological indicators and MACE

among the patients participating in this ex-

periment (Table 7).

DISCUSSION

PCI can markedly unblock the infarct-

ed CA and was chosen as the first-line treat-

ment strategy for STEMI clinical treatment.

Recent studies given a large sample suggest

that PCI can construct BF in >90% of IRA

and restore TMI to level 3

. However, the

effect of PCI is offset by some severe side ef-

fects. Slow/no BF is a risk element influenc-

ing the prognosis of SEMI patients. Some

drugs were utilized to enhance the thera-

peutic effect of PCI to enhance coronary BF

after PCI.

Compared to studies with TIF, few peo-

ple have focused on the influence of rh-BNP

on coronary BF after PCI. Guo et al. showed

that compared to patients treated with PCI

alone, rh-BNP can significantly reduce the

incidence of slow BF, indicating the potential

of rh-BNP to improve BF after PCI

. There-

fore, this study compared the therapeutic

influences of rh-BNP and TIF on PCI-related

slow/no flow. The outcomes demonstrated

that compared with TIF, administering rh-

BNP markedly reduced the occurrence of SF

after PCI.

Table 2

Information on drug combination use.

Characteristic rh-BNP (n=65) TIF (n=65) t/χ

p value

Ticagrelor (n, %) 59(90.8) 61(93.8) - 0.39

Statins (n, %) 62(95.4) 61(93.8) - 0.53

Nitrates (n, %) 45(69.2) 48(73.8) 0.443 0.44

β-blocker (n, %) 57(87.7) 52(80.0) 1.690 0.13

ACEI/ARB 52(80.0) 56(86.2) 1.259 0.29

CCB (n, %) 21(32.3) 22(33.8) 0.884 0.36

PPI (n, %) 48(73.8) 52(80.0) 0.705 0.44

Hypoglycemic drugs (n, %) 21(32.3) 23(35.4) 0.327 0.53

t: t-test, χ

: Chi-squared test; rh-BNP: B-type recombinant human brain natriuretic peptide; TIF: tirofiban; ACEI:

ACE inhibitor; ARB: angiotensin II receptor antagonist; CCB: calcium channel blocker (calcium antagonist); PPI:

proton pump inhibitor.

Benefits of natriuretic peptide in ST-segment elevation myocardial infarction 341

Vol. 65(3): 335 - 345, 2024

Table 3

Information on treatment outcomes for patients with myocardial infarction with elevation

of the segment ST (STEMI) and percutaneous coronary intervention (PCI) patients.

Characteristic rh-BNP (n=65) TIF (n=65) t/χ

p value

Number of branches

Single branch (n,%) 8(12.3) 7(10.8)

Double branches (n,%) 19(29.2) 17(26.2)

Three branches (n,%) 38(58.5) 41(63.1) 0.286 0.87

IRA distribution

LAD (n,%) 33 (50.8) 38(58.5)

LCX (n,%) 10 (15.4) 7(10.8)

RCA (n,%) 22 (33.8) 20(30.8) 0.977 0.61

TMI level before PCI

Level 0 (n,%) 19(29.2) 25(38.5) 2.298 0.51

Level 1 (n,%) 8(12.3) 8(12.3)

Level 2 (n,%) 9(13.8) 11(16.9)

Level 3 (n,%) 29(44.6) 21(32.3)

TMI level after PCI

Level 0 (n,%) 1(1.5) 2(2.3) - 0.03

Level 1 (n,%) 2(3.1) 7(6.9)

Level 2 (n,%) 6(9.2) 11(13.1)

Level 3 (n,%) 56(86.2) 45(77.7)

CTFC after PCI (FPS) 23.60±4.05 25.57±5.29 -2.381 0.02

Level 3 TMPG after PCI (n,%) 58(89.2) 49(75.5) 4.279 0.04

TS score before PCI 3(2,4) 3(2,4) -1.45 0.15

TS score after PCI 0(0,1) 1(0,1) -3.908 <0.001

TS score changes 3(2,3) 1(1,1) -4.263 <0.001

Support number 1(1,1) 1(1,2) -0.898 0.37

Support length(mm) 26.4±11.33 31.35±12.93 -2.323 0.02

Thrombotic aspiration during intervention (n,%) 15(23.1) 14(21.5) 0.044 0.83

Intraoperative hypotension (n,%) 5(7.7) 7(10.8) 0.367 0.55

Intraoperative systolic blood pressure (mmHg) 125.58±18.87 122.88±21.06 0.772 0.44

Intraoperative diastolic blood pressure (mmHg) 70.66±5.09 70.69±11.50 -0.2 0.98

HR (n/min) 72.23±8.46 72.58±7.65 -0.25 0.80

SF/no flow (n,%) 9(13.8) 20(30.8) 5.370 0.02

Use of sodium nitroprusside (n,%) 4(6.2) 15(23.1) - 0.01

t: t-test, χ2: Chi-squared test; rh-BNP: B-type recombinant human brain natriuretic peptide; TIF: tirofiban; CTFC:

corrected TMI frame count; FPS: frames per second; IRA: infarction-related artery; LAD: anterior descending

branch of left CA; LCX: left circumflex branch; PCI: primary PCI; RCA: right CA; rh-BNP: B-type recombinant hu-

man brain natriuretic peptide; TMI: thrombolysis for MI; TMPG: TMI myocardial perfusion level; TS: thrombotic

score; HR: heart rate; SF: slow flow

342 Shi et al.

Investigación Clínica 65(3): 2024

In addition, the thrombus score of pa-

tients receiving treatments with rh-BNP was

evidently lower than that of TIF. It may be

due to the more substantial thrombolytic

function of rh-BNP on existing thrombi in

the CA

. Regarding biochemical param-

eters, the two clinically recognized myo-

cardial function indicators, CK and CKMB,

showed significantly lower peak levels in the

RBG compared to the TIF group.

Table 4

Effects of two treating methods on ventricular function and ejection fraction.

Characteristic rh-BNP (n=65) TIF (n=65) t/χ

CK peak (U/L) 2108±1452 3562±1609 0.260 0.13

CKMB peak (U/L) 168.4±112.3 206.9±139.2 0.117 0.18

Ln (NT-proBNP) 5.96±0.75 7.43±0.93 0.122 0.15

LEVF 48.32±9.86 52.08±10.04 0.103 0.42

t: t-test, χ

: Chi-squared test; rh-BNP: B-type recombinant human brain natriuretic peptide; TIF: tirofiban; CK: cre-

atine kinase; CKMB: creatine kinase isozyme; NT-proBNP: N-terminal pro B-type natriuretic peptide.

Table 5

The impact of two treatment methods on the total STR at two hours after PCI surgery.

Characteristic rh-BNP (n=65) TIF (n=65) t/χ

Total STR after PCI surgery

<30% (n,%) 5(7.7) 12(18.5)

30%-70% (n,%) 13(21.5) 21(32.3)

>70% (n,%) 47(70.8) 32(49.2) 6.795 0.03

Total STR at two hours after PCI surgery

<30% (n,%) 3(4.6) 8(12.3)

30%-70% (n,%) 9(13.8) 12(18.5)

>70% (n,%) 53(81.5) 45(69.2) 3.408 0.17

t: t-test, χ

: Chi-squared test; Rh BNP: B-type recombinant human brain natriuretic peptide; TIF: tirofiban; PCI:

primary PCI; STR: ST-segment resolution.

Table 6

The impact of two treatment methods on the total STR at two hours after PCI surgery.

Characteristic rh-BNP (n=65) TIF (n=65) t/χ

Heart failure (n, %) 11(16.9) 23(35.4) 5.735 0.03

Mortality (n, %) 1(1.5) 0(0) - 0.32

Angina pectoris (n, %) 8(12.3) 18(27.7) 4.808 0.03

TMI level

Microbleeds (n, %) 17(26.2) 8(12.3) 4.011 0.04

GUSTO

pyorrhea (n, %) 17(26.2) 8(12.3) 4.011 0.05

t: t-test, χ

: Chi-squared test; PCI: primary PCI; STR: ST-segment resolution: rh-BNP: B-type recombinant human

brain natriuretic peptide; TIF: tirofiban; TMI: thrombolysis myocardial infarction; GUSTO: the application of strep-

tokinase and tissue type plasmin activator in the treatment of coronary occlusion.

Benefits of natriuretic peptide in ST-segment elevation myocardial infarction 343

Vol. 65(3): 335 - 345, 2024

At the same time, side effects were ab-

sent among the sufferers participating in

this experiment at the peak time point

. In

addition, the NT pro-BNP, which serves as a

marker for the degree of myocardial injury,

was also lower in the RBG than in the TIF

group

. These data clearly indicate that rh-

BNP has a more substantial protective effect

on PCI treatment-related injuries than TIF.

The electrocardiogram examination of

the patient’s myocardial function revealed

that the sum-STR changes in the RBG were

superior to those in the TIF group. Previous

studies demonstrated a positive correlation

between the recovery of myocardial ischemic

injury and the recovery of sum-STR

. Inte-

grated with the significant changes in LVEF

in the RBG, it can be seen that the improve-

ment in the influence of rh-BNP on myocar-

dial function is also more marked than that

of TIF. In addition, the incidence of MACE

in the RBG was below that in the TIF group,

representing rh-BNP’s safety in clinical ap-

plication. This study followed all patients

for 30 days after discharge, and the results

showed no differences in biochemical, myo-

cardial function, MACE, and other param-

eters between the two groups of patients,

further proving the potential of rh-BNP in

improving CA BF after PCI surgery. Existing

research also indicates that the influence

of rh-BNP on the heart is more pronounced

after intervening, but over time, the dispar-

ity in treating efficacy in the two drugs de-

creases. This decrease may be because of the

more substantial function of rh-BNP in en-

hancing microcirculation by dissolving small

blood clots

In conclusion, the current research

compared the effectiveness of rh-BNP and

TIF in preserving STEMI patients from PCI-

related ischemia/reperfusion (I/R) injury.

The results show that both drugs significant-

ly reduce the occurrence of SF and MCAE

and improve myocardial function. Addition-

ally, during the 30-day follow-up, rh-BNP

had a more substantial immediate effect on

most indicators after the intervention than

TIF. The safety of its application was similar,

suggesting good potential for clinical use in

treating PCI-related SF.

Notably, the study has various limita-

tions. Firstly, it is a retrospective study us-

ing case data, potentially introducing bias

and limiting the findings’ generalizability.

Secondly, the sample size is relatively small.

Thirdly, the study lacks information on the

long-term outcomes of the two treatment

Table 7

The impact of two treatment methods on the total STR at two hours after PCI surgery.

Characteristic rh-BNP (n=65) TIF (n=65) t/χ

CK (U/L) 82.50±27.29 80.66±29.18 0.369 0.71

CKMB (U/L) 12.58±6.76 12.63±6.91 0.046 0.95

HSCRP (mg/L) 2.18±1.09 2.52±1.61 1.381 0.16

Ln (NT-proBNP) 5.23±0.85 5.41±1.22 0.941 0.34

LVEF (%) 17(26.2) 8 (12.3) 4.011 0.04

Mortality 0 0 - -

Secondary MI 0 0 - -

Treatment Failure 5(7.8) 9(13.8) 1.209 0.26

Angina pectoris 7(10.9) 5(9.3) 0.427 0.55

t: t-test, χ

: Chi-squared test; PCI: primary PCI; STR: ST-segment resolution. rh-BNP: B-type recombinant human

brain natriuretic peptide; TIF: tirofiban; CK: creatine kinase; CK-MB: creatine kinase-myocardial band; NT-proBNP:

N-terminal pro b-type natriuretic peptide; LVEF: left ventricular ejection fraction.

344 Shi et al.

Investigación Clínica 65(3): 2024

methods, which is crucial for understanding

their overall effectiveness and safety.

ACKNOWLEDGMENTS

We want to express our gratitude to ev-

eryone who contributed their time, effort,

and expertise to make this study successful.

Funding

None

Conflict of interests

There are no conflicting interests

Authors’ ORCID number

• Dahuan Shi (DS):

0009-0005-3133-426X

• Xin Li (XL):

0000-0001-7588-3328

• Lantao Yang (LY):

0000-0002-0277-4355

• Chunmei Luo (CL):

0000-0002-8823-8296

• Jing Ma (JM):

0000-0002-6120-5857

Authors contribution

DS, XL: Designed the study work and

performed the experiments. LY, CL: Ana-

lyzed the data and wrote the manuscript.

JM: Drafted and edited the manuscript.

REFERENCES

1. Domienik-Karłowicz J, Kupczyńska K, Mi-

chalski B, Kapłon-Cieślicka A, Darocha

S, Dobrowolski P, Wybraniec M, Wańha W,

Jaguszewski M. Fourth universal definition

of myocardial infarction. Selected messa

ges from the European Society of Cardiolo-

gy document and lessons learned from the

new guidelines on ST-segment elevation

myocardial infarction and non-ST-segment

elevation-acute coronary syndrome. Car

diol J 2021;28(2):195-201. https://doi.

org/10.5603%2FCJ.a2021.0036.

2. Akbar H, Foth C, Kahloon RA, Mountfort

S. Acute ST-Elevation Myocardial Infarc

tion. StatPearls. Treasure Island (FL) ineli-

gible companies. StatPearls Publishing,

LLC.; 2024.

3. Mechanic OJ, Gavin M, Grossman SA.

Acute Myocardial Infarction. StatPearls.

Treasure Island (FL) ineligible companies.

StatPearls Publishing LLC.; 2024.

4. Ibanez B, James S, Agewall S, Antunes

MJ, Bucciarelli-Ducci C, Bueno H, Cafo

rio ALP, Crea F, Goudevenos JA, Halvor-

sen S, Hindricks G, Kastrati A, Lenzen

MJ, Prescott E, Roffi M, Valgimigli M, Var

enhorst C, Vranckx P, Widimský P, Group

ESD. 2017 ESC Guidelines for the mana

gement of acute myocardial infarction in

patients presenting with ST-segment eleva

tion: The Task Force for the management

of acute myocardial infarction in patients

presenting with ST-segment elevation of

the European Society of Cardiology (ESC).

Eur Heart J 2017;39(2):119-177. https://

doi.org/10.1093/eurheartj/ehx637

5. Elendu C, Amaechi DC, Elendu TC, Ome

ludike EK, Alakwe-Ojimba CE, Obidigbo

B, Akpovona OL, Oros Sucari YP, Saggi

SK, Dang K, Chinedu CP. Comprehensive

review of ST-segment elevation myocardial

infarction: Understanding pathophysio

logy, diagnostic strategies, and current

treatment approaches. Medicine (Baltimo

re) 2023;102(43):e35687. https://doi.org

/10.1097%2FMD.0000000000035687.

6. Szummer K, Jernberg T, Wallentin L. From

early pharmacology to recent pharmacology

interventions in acute coronarysyndromes:

JACC State-of-the-Art Review. J Am Coll

Cardiol 2019;74(12):1618-1636. https://

doi.org/10.1016/j.jacc.2019.03.531.

7. Donisan T, Balanescu DV, Iliescu G, Mar

magkiolis K, Iliescu C. Acute Coronary

Syndrome, Thrombocytopenia, and Anti

platelet Therapy in Critically Ill Cancer

Patients. In: Nates JL, Price KJ, editors.

Benefits of natriuretic peptide in ST-segment elevation myocardial infarction 345

Vol. 65(3): 335 - 345, 2024

Oncologic Critical Care. Cham: Springer

International Publishing; 2020. p. 711-732.

8. Li F, Li H, Luo R, Pei JB, Yu XY. Lyophili

zed recombinant human brain natriuretic

peptide for chronic heart failure: Effects

on cardiac function and inflammation.

World J Clin Cases 2023;11(26):6066-

6072. http://dx.doi.org/10.12998/wjcc.

v11.i26.6066.

9. Zhang S, Wang Z. Effect of recombi

nant human brain natriuretic peptide

(rhBNP) versus nitroglycerin in patients

with heart failure: A systematic review

and meta-analysis. Medicine (Baltimore)

2016;95(44):e4757. https://doi.org/10.10

97%2FMD.0000000000004757.

10. Zhou Y, Wang X, Yuan H, Wu L, Zhang B,

Chen X, Zhang Y. Impact of recombinant hu

man brain natriuretic peptide on emergency

dialysis and prognosis in end-stage renal di

sease patients with type 4 cardiorenal syndro-

me. Sci Rep. 2023;13(1):20752. https://doi.

org/10.1038/s41598-023-48125-1.

11. Liang L, Tang R, Xie Q, Han J, Li W. The

clinical effect of recombinant human brain

natriuretic peptide on asymptomatic peri-

procedural myocardial injury after percu

taneous transluminal coronary angioplas-

ty. Sci Rep. 2020;10(1):15902. https://doi.

org/10.1038/s41598-020-72710-3.

12. Kampinga MA, Vlaar PJ, Fokkema M, Gu

YL, Zijlstra F. Thrombus Aspiration during

percutaneous coronary intervention in

acute non-ST-elevation myocardial infarc

tion Study (TAPAS II)-Study design. Neth

Heart J 2009;17(11):409-413. https://doi.

org/10.1007/bf03086293.

13. Guo Z, Liu W, Xin S, Nizzati M, Li G.

Follow-up observation of one year’s

treatment of acute ST-elevated myocardial

infarction via reverse thrombolysis com

bined PCI surgery. J Xinjiang Med Univ.

2017;40(1):4.14.

14. Zhao L, Zhao Z, Chen X, Li J, Liu J, Li

G. Safety and efficacy of prourokinase in

jection in patients with ST-elevation myo-

cardial infarction: phase IV clinical trials

of the prourokinase phase study. Heart

Vessels. 2018;33(5):507-512. https://doi.

org/10.1007/s00380-017-1097-x.

15. Zhonghua Z, Xue X, Bing G, Zhi Z. [2019

Chinese Society of Cardiology (CSC) gui

delines for the diagnosis and manage-

ment of patients with ST-segment eleva-

tion myocardial infarction]. Zhonghua xin

xue guan bing za zhi. 2019;47(10):766-

783. https://doi.org/10.3760/cma.j.is

sn.0253-3758.2019.10.003.

16. Cao Z, Jia Y, Zhu B. BNP and NT-proBNP

as diagnostic biomarkers for cardiac dys

function in both clinical and forensic medi-

cine. Int J Mol Sci 2019;20(8):1820. https://

doi.org/10.3390%2Fijms20081820.

17. Van ’t Hof AW, Liem A, de Boer MJ, Zijlstra

F. Clinical value of 12-lead electrocardiogram

after successful reperfusion therapy for acu

te myocardial infarction. Zwolle Myocardial

infarction Study Group. Lancet (London,

England). 1997;350(9078):615-9. https://

doi.org/10.1016/s0140-6736(96)07120-6.