The impact of recombinant human brain natriuretic peptide on clinical efficacy in patients with acute ischemic chest pain undergoing PCI

To systematically investigate the clinical efficacy and safety of recombinant human brain natriuretic peptide (rhBNP) as an adjunctive therapy in patients with acute ischemic chest pain undergoing percutaneous coronary intervention (PCI). In this prospective, single-center, non-randomized study,195 patients were allocated based on preference to receive standard guideline-directed medical therapy (GDMT; control group, n = 95) or GDMT plus rhBNP (treatment group, n = 99). rhBNP was administered as an intravenous bolus of 1.5 µg/kg followed by continuous infusion at 0.0075 µg/kg/min for up to 72 h. Given the non-randomized design, between-group comparisons are exploratory and hypothesis-generating. The rhBNP group presented with more severe baseline characteristics (older age, higher heart rate, and a greater proportion of Killip class III/IV patients). At 72 h, the treatment group showed a higher left ventricular ejection fraction (LVEF) (59.48 ± 5.02% vs. 53.71 ± 15.55%, P = 0.001) and lower heart rates (59.21 ± 4.09 vs. 67.78 ± 6.56 bpm, P < 0.001). Cardiac troponin levels were lower ( P < 0.001), and the incidence of major adverse cardiovascular events (MACE) was lower in the rhBNP group (3.0% vs. 58.9%, P < 0.001). Hospitalization was longer in the treatment group, while rates of renal function deterioration and bleeding were lower. These unadjusted, between-group associations are limited by the non-randomized design and baseline imbalances, and should be interpreted as hypothesis-generating. In this non-randomized, single-center study, adjunctive rhBNP therapy was associated with more favorable cardiac function indices, lower myocardial injury biomarkers, and lower observed rates of MACE and renal function deterioration. These hypothesis-generating findings are limited by the non-randomized design, baseline imbalances, and absence of adjusted analyses, and require confirmation in a well-designed prospective randomized controlled trial.