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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
authors.affiliation: Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.forename: Peter W
authors.initials: PW
authors.lastname: Radke
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yu
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D020097:Natriuretic Peptide, Brain; D003404:Creatinine