Abstract
Introduction The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization. Infusion of low dose recombinant human brain natriuretic peptide (rhBNP) at the time of AMI is well tolerated and could improve cardiac function.Objective The objective of this study was to evaluate the hemodynamic effects of rhBNP in AMI patients revascularized by emergency percutaneous coronary intervention (PCI) who developed cardiogenic shock.Methods A total of 48 patients with acute ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and whose hemodynamic status was improved following emergency PCI were enrolled. Patients were randomly assigned to rhBNP (n=25) and control (n=23) groups. In addition to standard therapy, study group individuals received rhBNP by continuous infusion at 0.005 µg kg−1 min−1 for 72 hours.Results Baseline characteristics, medications, and peak of cardiac troponin I (cTnI) were similar between both groups. rhBNP treatment resulted in consistently improved pulmonary capillary wedge pressure (PCWP) compared to the control group. Respectively, 7 and 9 patients died in experimental and control groups. No drug-related serious adverse events occurred in either group.Conclusion When added to standard care in stable patients with cardiogenic shock complicating anterior STEMI, low dose rhBNP improves PCWP and is well tolerated.
Highlights
The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization
Baseline characteristics, medications, and peak of cardiac troponin I were similar between both groups. recombinant human brain natriuretic peptide (rhBNP) treatment resulted in consistently improved pulmonary capillary wedge pressure (PCWP) compared to the control group
We proposed a pilot study to evaluate the safety and efficacy of low dose rhBNP in the setting of segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock
Summary
The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization. Emergency revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) has been shown to improve long-term survival of these patients[2,3,4]. Despite this progress, cardiogenic shock continues to be associated with a high short-term mortality rate[5]. B type natriuretic peptide (BNP), released due to altered chamber loading and myocyte stretch, has been detected in acute myocardial infarction (AMI)[8,9]. Exogenous BNP infusion may result in coronary vasodilatation with reduced myocardial oxygen consumption[11], enhanced myocardial relaxation[12], suppressed synthesis and release of aldosterone[13], induced vascular regeneration[14], delayed adrenergic activation and inhibited cardiac fibroblast collagen synthesis[15,16,17]
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