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document
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 . 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 .
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Intervention_Surgical
percutaneous coronary intervention
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Intervention_Physical
BNP levels
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Intervention_Surgical
percutaneous coronary intervention
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Outcome_Physical
development
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Outcome_Physical
BNP levels
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Outcome_Physical
CI-AKI
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Participant_Condition
contrast-induced acute kidney injury in acute ST-segment-elevation myocardial infarction :