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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; 5(6):813-20CC

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, 1.14-1.51; P=0.0001). After multivariable adjustment for clinical, laboratory, and angiographic variables, BNP remained a significant independent predictor of CI-AKI (1.29 [1.10, 1.51]; P<0.001). Significant net reclassification improvement was achieved by addition of BNP to the current clinical risk prediction model (net reclassification improvement=0.177; P<0.001) 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.

Authors+Show Affiliations

Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23192919

Citation

Jarai, Rudolf, et al. "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." Circulation. Cardiovascular Interventions, vol. 5, no. 6, 2012, pp. 813-20.
Jarai R, Dangas G, Huber K, et al. 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;5(6):813-20.
Jarai, R., Dangas, G., Huber, K., Xu, K., Brodie, B. R., Witzenbichler, B., ... Stone, G. W. (2012). 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. Circulation. Cardiovascular Interventions, 5(6), pp. 813-20. doi:10.1161/CIRCINTERVENTIONS.112.972356.
Jarai R, et al. 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;5(6):813-20. PubMed PMID: 23192919.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Jarai,Rudolf, AU - Dangas,George, AU - Huber,Kurt, AU - Xu,Ke, AU - Brodie,Bruce R, AU - Witzenbichler,Bernhard, AU - Metzger,D Christopher, AU - Radke,Peter W, AU - Yu,Jennifer, AU - Claessen,Bimmer E, AU - Genereux,Philippe, AU - Mehran,Roxana, AU - Stone,Gregg W, Y1 - 2012/11/27/ PY - 2012/11/30/entrez PY - 2012/11/30/pubmed PY - 2013/6/5/medline SP - 813 EP - 20 JF - Circulation. Cardiovascular interventions JO - Circ Cardiovasc Interv VL - 5 IS - 6 N2 - 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, 1.14-1.51; P=0.0001). After multivariable adjustment for clinical, laboratory, and angiographic variables, BNP remained a significant independent predictor of CI-AKI (1.29 [1.10, 1.51]; P<0.001). Significant net reclassification improvement was achieved by addition of BNP to the current clinical risk prediction model (net reclassification improvement=0.177; P<0.001) 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. SN - 1941-7632 UR - https://www.unboundmedicine.com/medline/citation/23192919/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_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.112.972356?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -