title: N-Terminal Fragment of Pro B-type Natriuretic Peptide as a Marker of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.
abstract: Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is frequent and associated with long-term renal impairment and mortality. Early markers of CIN are needed to improve risk stratification. We aimed to assess whether N-terminal fragment of pro B-type natriuretic peptide (Nt-proBNP) could be associated with CIN. From the French regional RICO survey, all the consecutive patients who underwent primary PCI for STEMI, from January 1, 2001, to December 3, 2013, were included. Nt-proBNP circulating levels were assessed on admission. CIN was defined as an increase in serum creatinine >26.5 μmol/L or >50% within 48 to 72 hours after PCI (KDIGO criteria). Of the 1,243 patients included, CIN occurred in 130 patients (10.4%). Nt-proBNP levels were 5 times greater in patients who developed CIN than without CIN (1,275 [435 to 4,022] vs 247 [79 to 986] pg/mL, p <0.001). Hospital mortality rate was markedly higher in patients with CIN (6.9% vs 1.1%, p <0.001). Nt-proBNP levels were univariate predictors for CIN as were age, hypertension, diabetes, smoking, previous stroke, heart rate, impaired left ventricular ejection fraction C-reactive protein, history of renal failure, anemia, and estimated glomerular filtration rate <30 ml/min/1.73 m(2) at baseline. Nt-proBNP levels remained strongly associated with the occurrence of CIN even after adjustment for risk factors, treatments, clinical and biological variables (odds ratio 1.99, 95% confidence interval 1.49 to 2.66). Net reclassification improvement was achieved by the addition of Nt-proBNP to the risk model (p = 0.003). In conclusion, from this large contemporary prospective study in nonselected population, our work suggests that Nt-proBNP levels at admission could help to identify patients at risk of CIN beyond traditional risk factors.
authors.affiliation: Service de Cardiologie, CHU, Dijon, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Goussot
authors.affiliation: Service de Néphrologie, CHU, Dijon, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Mousson
authors.affiliation: Service de Cardiologie, CHU, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: Service de Cardiologie, CHU, Dijon, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Stamboul
authors.affiliation: Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunel
authors.affiliation: Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Brunet
authors.affiliation: Service de Cardiologie, CHU, Dijon, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Touzery
authors.affiliation: Service de Cardiologie, CHU, Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Laboratoire de Physiopathologie et Pharmacologie Cardiométaboliques, INSERM UMR866, Université de Bourgogne-Franche Comté, Dijon, France. Electronic address: marianne.zeller@u-bourgogne.fr.
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000139:chemically induced / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain