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

Rudolf Jarai, George Dangas, Kurt Huber, Ke Xu, Bruce R. Brodie, Bernhard Witzenbichler, D. Christopher Metzger, Peter W. Radke, Jennifer Yu, Bimmer E. Claessen, Philippe Genereux, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

27 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)813-820
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume5
Issue number6
DOIs
StatePublished - Dec 1 2012

Fingerprint

Brain Natriuretic Peptide
Acute Kidney Injury
Stents
Myocardial Infarction
Percutaneous Coronary Intervention
ST Elevation Myocardial Infarction
Serum
Hospital Emergency Service
Creatinine
Logistic Models
Odds Ratio
Regression Analysis
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Jarai, Rudolf ; Dangas, George ; Huber, Kurt ; Xu, Ke ; Brodie, Bruce R. ; Witzenbichler, Bernhard ; Metzger, D. Christopher ; Radke, Peter W. ; Yu, Jennifer ; Claessen, Bimmer E. ; Genereux, Philippe ; Mehran, Roxana ; Stone, Gregg W. / 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. In: Circulation: Cardiovascular Interventions. 2012 ; Vol. 5, No. 6. pp. 813-820.
@article{61934a1aac3546139d6ca648a4951ac1,
title = "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",
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.",
author = "Rudolf Jarai and George Dangas and Kurt Huber and Ke Xu and Brodie, {Bruce R.} and Bernhard Witzenbichler and Metzger, {D. Christopher} and Radke, {Peter W.} and Jennifer Yu and Claessen, {Bimmer E.} and Philippe Genereux and Roxana Mehran and Stone, {Gregg W.}",
year = "2012",
month = "12",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.112.972356",
language = "English (US)",
volume = "5",
pages = "813--820",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

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. / Jarai, Rudolf; Dangas, George; Huber, Kurt; Xu, Ke; Brodie, Bruce R.; Witzenbichler, Bernhard; Metzger, D. Christopher; Radke, Peter W.; Yu, Jennifer; Claessen, Bimmer E.; Genereux, Philippe; Mehran, Roxana; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 5, No. 6, 01.12.2012, p. 813-820.

Research output: Contribution to journalArticle

TY - JOUR

T1 - B-type natriuretic peptide and risk of contrast-induced acute kidney injury in acute ST-segment-elevation myocardial infarction

T2 - 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.

PY - 2012/12/1

Y1 - 2012/12/1

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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84873622099&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873622099&partnerID=8YFLogxK

U2 - 10.1161/CIRCINTERVENTIONS.112.972356

DO - 10.1161/CIRCINTERVENTIONS.112.972356

M3 - Article

VL - 5

SP - 813

EP - 820

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 6

ER -