Key result
Low-dose rhBNP lowers PCWP by ~4 mmHg more than standard care in cardiogenic shock.
Why the study?
Does low-dose recombinant human brain natriuretic peptide improve pulmonary capillary wedge pressure in patients with anterior STEMI complicated by cardiogenic shock after emergency PCI?
RCT (n=48)
Open-label
1:1 ratio (sealed enveloped)
No
Does low-dose recombinant human brain natriuretic peptide improve pulmonary capillary wedge pressure in patients with anterior STEMI complicated by cardiogenic shock after emergency PCI?
Absolute Event Rate: -9.3% vs -5.3%
p-value: p=0.002
Low-dose rhBNP effectively reduces pulmonary capillary wedge pressure without significantly affecting renal function in stable patients with cardiogenic shock complicating anterior STEMI.
May aid short-term hemodynamic stabilization in STEMI shock; extends rhBNP evidence from HF to post-MI cardiogenic shock.
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.
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Pan et al. (2017) conducted an RCT in Acute ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (n=48). Recombinant human brain natriuretic peptide (rhBNP) vs. Control (Standard care) was evaluated on Absolute changes in pulmonary capillary wedge pressure (PCWP) from baseline to 72 hours after randomization (p=0.002). Low-dose recombinant human brain natriuretic peptide significantly improved pulmonary capillary wedge pressure at 72 hours (-9.3 mmHg vs -5.3 mmHg, p=0.002) compared to standard care in patients with anterior STEMI complicated by cardiogenic shock.
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