title: Atrial natriuretic peptide therapy and in-hospital mortality in acute myocardial infarction patients undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  Atrial natriuretic peptide (ANP) therapy has been reported to have beneficial effects in patients with acute myocardial infarction (AMI); however, its impact on in-hospital mortality remains unclear. This study aimed to investigate the effects of ANP therapy on in-hospital mortality in AMI patients undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  This was a retrospective cohort study using the Diagnosis Procedure Combination inpatient database in Japan. We identified AMI patients who underwent PCI with stent implantation on the day of admission, between 2010 and 2014. We compared 30-day in-hospital mortality between patients who started ANP therapy on the day of admission (ANP group) and those who received no ANP therapy during hospitalization (control group), using propensity score and instrumental variable methods.
  
  
  RESULTS
  Of 60,592 eligible patients (8189 ANP group, 52,403 control group) from 850 hospitals, 1:1 propensity score matching created 8027 pairs. There was no significant difference in 30-day in-hospital mortality between the ANP and control groups (3.4% vs. 3.8%, respectively; p=0.162; risk difference, -0.42%; 95% confidence interval [CI], -1.00% to 0.15%) in the propensity score-matched cohort. Logistic regression analysis with adjustment for propensity score deciles found no significant association between ANP therapy and 30-day in-hospital mortality (odds ratio, 0.99; 95% CI, 0.82 to 1.19). Instrumental variable analysis also showed no significant association between ANP therapy and 30-day in-hospital mortality (risk difference, -0.59%; 95% CI, -1.24% to 0.05%).
  
  
  CONCLUSIONS
  This study found no significant association between ANP therapy and in-hospital mortality in AMI patients undergoing PCI.
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Electronic address: toisogai-circ@umin.ac.jp.
authors: Toshiaki
authors: T
authors: Isogai
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors: Hiroki
authors: H
authors: Matsui
authors: Department of Cardiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan.
authors: Hiroyuki
authors: H
authors: Tanaka
authors: Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
authors: Kiyohide
authors: K
authors: Fushimi
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors: Hideo
authors: H
authors: Yasunaga
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013223:Statistics as Topic; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D009320:Atrial Natriuretic Factor
keywords: Acute myocardial infarction; Atrial natriuretic peptide; In-hospital mortality; Percutaneous coronary intervention