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B-type Natriuretic Peptide and Risk of Contrast-Induced Acute Kidney Injury in Acute ST-Segment Elevation Myocardial Infarction: A Substudy from the HORIZONS-AMI Trial.
Circ Cardiovasc Interv. 2012 Nov 27;
Authors: Jarai R, Dangas G, Huber K, Xu K, Brodie BR, Witzenbichler B, Metzger DC, Radke PW, Yu J, Claessen BE, Genereux P, Mehran R, Stone GW
Abstract
BACKGROUND: CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) AFTER PERCUTANEOUS CORONARY INTERVENTION IS ASSOCIATED WITH ADVERSE SHORT- AND LONG-TERM OUTCOMES. HOWEVER, IDENTIFICATION OF PATIENTS AT RISK FOR CI-AKI IS CHALLENGING. USING A LARGE CONTEMPORARY RANDOMIZED TRIAL DATABASE OF PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION, WE THEREFORE SOUGHT TO EXAMINE WHETHER ADMISSION B-TYPE NATRIURETIC PEPTIDE (BNP) LEVELS PREDICT THE DEVELOPMENT OF CI-AKI.METHODS AND RESULTS: A TOTAL OF 979 ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS ENROLLED IN THE HARMONIZING OUTCOMES WITH REVASCULARIZATION AND STENTS IN ACUTE MYOCARDIAL INFARCTION (HORIZONS-AMI) TRIAL HAD BNP LEVELS MEASURED IN THE EMERGENCY ROOM PRIOR TO PRIMARY PERCUTANEOUS CORONARY INTERVENTION AS PART OF THE STUDY PROTOCOL. CI-AKI WAS DEFINED AS A RELATIVE INCREASE IN SERUM CREATININE OF 25%, OR AN ABSOLUTE INCREASE OF 0.5 MG/DL, OCCURRING WITHIN 48 HOURS AFTER CONTRAST ADMINISTRATION. LOGISTIC REGRESSION ANALYSIS WAS USED TO ESTIMATE THE ASSOCIATION OF ADMISSION BNP WITH DEVELOPMENT OF CI-AKI. CI-AKI OCCURRED IN 131 PATIENTS (13.3%). BASELINE BNP WAS A SIGNIFICANT UNIVARIABLE CORRELATE OF CI-AKI (ODDS RATIO 1.31, 95% CONFIDENCE INTERVAL, 1.141.51; P=0.0001). AFTER MULTIVARIABLE ADJUSTMENT FOR CLINICAL, LABORATORY, AND ANGIOGRAPHIC VARIABLES, BNP REMAINED A SIGNIFICANT INDEPENDENT PREDICTOR OF CI-AKI (1.31 [1.14, 1.51]; P0.001). SIGNIFICANT NET RECLASSIFICATION IMPROVEMENT WAS ACHIEVED BY ADDITION OF BNP TO THE CURRENT CLINICAL RISK PREDICTION MODEL (NET RECLASSIFICATION IMPROVEMENT=0.156; P0.001) AND TO THE MEHRAN RISK SCORE (NET RECLASSIFICATION IMPROVEMENT=0.100; P=0.015).CONCLUSIONS: MEASUREMENT OF SERUM BNP AT HOSPITAL ADMISSION MAY HELP IDENTIFY PATIENTS WHO ARE AT RISK FOR DEVELOPING CI-AKI AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
PMID: 23192919 [PubMed - as supplied by publisher]