Benefits of recombinant human brain natriuretic peptide to improve ventricular function and hemodynamics in patients with ST-elevation myocardial infarction.

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.

• Dahuan Shi Central Hospital, Baoding, China. https://orcid.org/0009-0005-3133-426X
• Xin Li Central Hospital, Baoding, China. https://orcid.org/0000-0001-7588-3328
• Lantao Yang Central Hospital, Baoding, China. https://orcid.org/0000-0002-0277-4355
• Chunmei Luo Central Hospital, Baoding, China. https://orcid.org/0000-0002-8823-8296
• Jing Ma Hospital of Hebei University, Baoding, China. https://orcid.org/0000-0002-6120-5857

DOI: https://doi.org/10.54817/IC.v65n3a06

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 ventricular 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.

References

Domienik-Karłowicz J, Kupczyńska K, Michalski B, Kapłon-Cieślicka A, Darocha S, Dobrowolski P, Wybraniec M, Wańha W, Jaguszewski M. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J 2021;28(2):195-201. https://doi. org/10.5603%2FCJ.a2021.0036.

Akbar H, Foth C, Kahloon RA, Mountfort S. Acute ST-Elevation Myocardial Infarction. StatPearls. Treasure Island (FL) ineligible companies. StatPearls Publishing, Copyright © 2024, StatPearls Publishing LLC.; 2024.

Mechanic OJ, Gavin M, Grossman SA. Acute Myocardial Infarction. StatPearls. Treasure Island (FL) ineligible companies. StatPearls Publishing, Copyright © 2024, StatPearls Publishing LLC.; 2024.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P, Group ESD. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: 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

Elendu C, Amaechi DC, Elendu TC, Omeludike 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 pathophysiology, diagnostic strategies, and current treatment approaches. Medicine (Baltimore) 2023;102(43):e35687. https://doi.org/10.1097%2FMD.0000000000035687.

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.

Donisan T, Balanescu DV, Iliescu G, Marmagkiolis K, Iliescu C. Acute Coronary Syndrome, Thrombocytopenia, and Anti-platelet Therapy in Critically Ill Cancer Patients. In: Nates JL, Price KJ, editors.

Li F, Li H, Luo R, Pei JB, Yu XY. Lyophilized 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.

Zhang S, Wang Z. Effect of recombinant 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.

Zhou Y, Wang X, Yuan H, Wu L, Zhang B, Chen X, Zhang Y. Impact of recombinant human brain natriuretic peptide on emergency dialysis and prognosis in end-stage renal disease patients with type 4 cardiorenal syndrome. Sci Rep. 2023;13(1):20752. https://doi. org/10.1038/s41598-023-48125-1.

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 percutaneous transluminal coronary angioplasty. Sci Rep. 2020;10(1):15902. https://doi. org/10.1038/s41598-020-72710-3.

Kampinga MA, Vlaar PJ, Fokkema M, Gu YL, Zijlstra F. Thrombus Aspiration during percutaneous coronary intervention in acute non-ST-elevation myocardial infarction Study (TAPAS II)-Study design. Neth Heart J 2009;17(11):409-413. https://doi. org/10.1007/bf03086293.

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 combined PCI surgery. J Xinjiang Med Univ. 2017;40(1):4.14.

Zhao L, Zhao Z, Chen X, Li J, Liu J, Li G. Safety and efficacy of prourokinase injection in patients with ST-elevation myocardial 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.

Zhonghua Z, Xue X, Bing G, Zhi Z. [2019 Chinese Society of Cardiology (CSC) guidelines for the diagnosis and management of patients with ST-segment elevation 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.

Cao Z, Jia Y, Zhu B. BNP and NT-proBNP as diagnostic biomarkers for cardiac dysfunction in both clinical and forensic medicine. Int J Mol Sci 2019;20(8):1820. https:// doi.org/10.3390%2Fijms20081820.

Van ’t Hof AW, Liem A, de Boer MJ, Zijlstra F. Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute 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.