Abstract
Objectives We aimed to investigate the effects of Shen-Yuan-Dan (SYD), a Chinese medicine preparation, on periprocedural myocardial injury (PMI) and the number of peripheral blood endothelial progenitor cells (EPCs) in patients with unstable angina pectoris (UA) who underwent elective percutaneous coronary intervention (PCI). Methods Patients were randomly divided into the experimental (group A) and control (group B) groups through the random number table method. In group A, patients concurrently received the conventional western treatment and SYD orally (4 capsules/time, 3 times/d, from 3 d before surgery to 7 d after surgery). In group B, patients received conventional Western medicine treatment. Both groups underwent coronary angiography, and patients undergoing PCI were eventually included in the study. The following patient data were collected: incidence of PMI, serum CK-MB content before PCI, 4 h, 24 h, and 7 d after PCI, number of CD45dim/-CD34+CD309+ peripheral venous EPCs, and number of CD184 coexpressed EPCs. The incidence of adverse reactions and 30-day major adverse cardiovascular events (MACEs) were also recorded. Results Sixty-two patients were finally included in this study, with 32 and 30 in groups A and B, respectively. In group A, the number of peripheral blood EPCs and the number of CD184 coexpressed EPCs at 1 h before surgery were higher than those at 3 d before surgery (37.24 ± 25.20 vs. 22.78 ± 9.60/ml; P < 0.001 and 23.38 ± 15.30 vs. 13.54 ± 8.08/ml; P < 0.001, resp.). The number of peripheral blood EPCs and number of CD184 coexpressed EPCs at 4 h after surgery were lower than those at 1 h before surgery (25.30 ± 11.90 vs. 37.24 ± 25.20/ml; P=0.019 and 15.38 ± 8.78 vs. 23.38 ± 15.30/ml; P=0.013, resp.), but there was no difference at 24 h and at 7 d after surgery in comparison with that at 1 h before surgery (P > 0.05). In group B, compared with that at 1 h before surgery, there existed a decline in the number of EPCs in peripheral blood and the number of CD184 coexpressed EPCs at 4 h after surgery, but without a statistical difference (P > 0.05). Comparing both groups, it was found that the incidence of PMI in group A was lower (6.25% vs. 26.67%; P=0.04), and the serum CK-MB content at 4 and 24 h after surgery was also lower than that in group B (17.33 ± 5.83 vs. 20.38 ± 4.32 U/l; P=0.048 and 15.79 ± 5.32 vs. 19.10 ± 4.93 U/l; P=0.030, resp.). The number of EPCs in peripheral blood and the number of CD184 coexpressed EPCs in group A were higher than those in group B at 1 h before surgery (37.24 ± 25.20 vs. 22.36 ± 12.26/ml; P=0.034 and 23.38 ± 15.30 vs. 13.12 ± 14.62/ml; P=0.013, resp.). In addition, there were no obvious adverse reactions and no 30-day MACEs in both groups during the trial. Conclusion SYD can reduce PMI and promote the mobilization of EPCs in the perioperative period of elective PCI in patients with UA.
Highlights
Unstable angina (UA) is a serious coronary artery disease (CAD)
Reports have shown that the incidence of periprocedural myocardial injury (PMI) ranges from 14% to 52% [3], and its severity is associated with an increased risk of major adverse cardiovascular events (MACEs), such as death, reinfarction, and revascularization [4, 5]. e study related to ARMYDA showed that preoperative loading of atorvastatin calcium could reduce the occurrence of PMI [6,7,8], but this result has not been effectively confirmed in the Asian population [9]. erefore, investigating drugs that can effectively prevent PMI remains a hot spot in medical research [10]
As a common complication of Percutaneous coronary intervention (PCI) treatment, the mechanism of PMI is mainly related to side branch occlusion, distal vascular embolism, vascular endothelial dysfunction, and other factors [3]. e normal vascular endothelium is composed of single-layer endothelial cells and connected with the extracellular matrix through integrins [21], which plays an important role in maintaining the balance of the coagulation and fibrinolysis system and regulating vascular tension [22]
Summary
Percutaneous coronary intervention (PCI) is the major revascularization strategy for patients with CAD, and approximately 5 million PCI surgeries are performed every year worldwide [1]. Shen-Yuan-Dan (SYD) is a Chinese medicine preparation that is effective in the treatment of CAD [13, 14]. Previous studies have shown that SYD could reduce myocardial injury and oxidative stress levels during perioperative PCI in Chinese miniswines [15]. SYD can reduce oxidative stress in the perioperative period of PCI, but its influence on EPCs is currently unknown. SYD can reduce oxidative stress in the perioperative period of PCI, but its influence on EPCs is currently unknown. erefore, in this study, the effect of SYD on the number and function of EPCs during the perioperative period of PCI was investigated with the aim of further exploring its mechanism of myocardial protection during the perioperative period of PCI
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