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Lassus J, Tarvasmäki T, Tolppanen H. Biomarkers in cardiogenic shock. Adv Clin Chem 2022; 109:31-73. [DOI: 10.1016/bs.acc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Background The Zwolle Risk Score (ZRS) identifies primary percutaneous coronary intervention (PPCI) patients at low mortality risk, eligible for early discharge. Recently, this score was improved by adding baseline NT-proBNP. However, the optimal timepoint for NT-proBNP measurement is unknown. Methods PPCI patients in the On-Time 2 study were candidates. The ZRS and NT-proBNP levels on admission, at 18–24 h, at 72–96 h, and the change in NT-proBNP from baseline to 18–24 h (delta NT-proBNP) were determined. We investigated whether addition of the different NT-proBNP measurements to the ZRS improves the prediction of 30-day mortality. Based on cut-off values reflecting zero mortality at 30 d, patients who potentially could be discharged early were identified and occurrence of major adverse cardiac events (MACE) and major bleeding until 10 d was registered. Results 845 patients were included. On multivariate analyses, NT-proBNP at baseline (HR 2.09, 95% CI 1.59–2.74, p < 0.001), at 18–24 h (HR 6.83, 95% CI 2.94–15.84), and at 72–96 h (HR 3.32, 95% CI 1.22–9.06) independently predicted death at 30 d. Addition of NT-proBNP to the ZRS improved prediction of mortality, particularly at 18–24 h (net reclassification index 29%, p < 0.0001, integrated discrimination improvement 17%, p < 0.0001). Based on ZRS (<2) or NT-proBNP at 18–24 h (<2500 pg/ml) 75% of patients could be targeted for early discharge at 48 h, with expected re-admission rates of 1.2% due to MACE and/or major bleeding. Conclusions NT-proBNP at different timepoints improves prognostication of the ZRS. Particularly at 18–24 h post PPCI, the largest group of patients that potentially could be discharged early was identified. Electronic supplementary material The online version of this article (doi: 10.1007/s12471-016-0935-2) contains supplementary material, which is available to authorized users.
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He PC, Duan CY, Liu YH, Wei XB, Lin SG. N-terminal pro-brain natriuretic peptide improves the C-ACS risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction. BMC Cardiovasc Disord 2016; 16:255. [PMID: 27955618 PMCID: PMC5153866 DOI: 10.1186/s12872-016-0430-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background It remained unclear whether the combination of the Canada Acute Coronary Syndrome Risk Score (CACS-RS) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) could have a better performance in predicting clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention. Methods A total of 589 consecutive STEMI patients were enrolled. The potential additional predictive value of NT-pro-BNP with the CACS-RS was estimated. Primary endpoint was in-hospital mortality and long-term poor outcomes. Results The incidence of in-hospital death was 3.1%. Patients with higher NT-pro-BNP and CACS-RS had a greater incidence of in hospital death. After adjustment for the CACS-RS, elevated NT-pro-BNP (defined as the best cutoff point based on the Youden’s index) was significantly associated with in hospital death (odd ratio = 4.55, 95%CI = 1.52–13.65, p = 0.007). Elevated NT-pro-BNP added to CACS-RS significantly improved the C-statistics for in-hospital death, as compared with the original score (0.762 vs. 0.683, p = 0.032). Furthermore, the addition of NT-pro-BNP to CACS-RS enhanced net reclassification improvement (0.901, p < 0.001) and integrated discrimination improvement (0.021, p = 0.033), suggesting effective discrimination and reclassification. In addition, the similar result was also demonstrated for in-hospital major adverse clinical events (C-statistics: 0.736 vs. 0.695, p = 0.017) or 3-year mortality (0.699 vs. 0.604, p = 0.004). Conclusions Both NT-pro-BNP and CACS-RS are risk predictors for in hospital poor outcomes in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcome s in these patients.
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Affiliation(s)
- Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Chong-Yang Duan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou, China.,Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Xue-Biao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Shu-Guang Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.
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Does N-terminal pro-brain natriuretic peptide add prognostic value to the Mehran risk score for contrast-induced nephropathy and long-term outcomes after primary percutaneous coronary intervention? Int Urol Nephrol 2016; 48:1675-82. [PMID: 27473154 DOI: 10.1007/s11255-016-1348-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the prognostic value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in relation to Mehran risk score (MRS) for contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS We prospectively enrolled 283 consecutive patients treated with PPCI for STEMI. NT-proBNP was measured, and the MRS was calculated. The primary end point was CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL from baseline within 48-72 h after contrast medium exposure. RESULTS The incidence of CIN was 9.2 %. Patients with CIN had higher NT-proBNP and MRS than those without CIN. The value of NT-proBNP was similar to MRS for CIN (C statistics 0.760 vs. 0.793, p = 0.689). After adjustment for MRS, elevated NT-proBNP (defined as the best cutoff point) was significantly associated with CIN. The addition of elevated NT-proBNP to MRS did not significantly improve the C statistics, over that with the original MRS model (0.833 vs. 0.793, p = 0.256). In addition, similar results were observed for in-hospital and long-term major adverse clinical events. CONCLUSIONS Although NT-proBNP did not add any prognostic value to the MRS model for CIN, NT-proBNP, as a simple biomarker, was similar to MRS, and may be another useful and rapid screening tool for CIN and death risk assessment, identifying subjects who need therapeutic measures to prevent CIN.
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Natriuretic peptides in percutaneous coronary intervention: Aren't they all the same? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:149-50. [PMID: 27157291 DOI: 10.1016/j.carrev.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ramipril and Losartan Exert a Similar Long-Term Effect upon Markers of Heart Failure, Endogenous Fibrinolysis, and Platelet Aggregation in Survivors of ST-Elevation Myocardial Infarction: A Single Centre Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9040457. [PMID: 27064499 PMCID: PMC4811062 DOI: 10.1155/2016/9040457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Blocking the renin-angiotensin-aldosterone system in ST-elevation myocardial infarction (STEMI) patients prevents heart failure and recurrent thrombosis. Our aim was to compare the effects of ramipril and losartan upon the markers of heart failure, endogenous fibrinolysis, and platelet aggregation in STEMI patients over the long term. Methods. After primary percutaneous coronary intervention (PPCI), 28 STEMI patients were randomly assigned ramipril and 27 losartan, receiving therapy for six months with dual antiplatelet therapy (DAPT). We measured N-terminal proBNP (NT-proBNP), ejection fraction (EF), plasminogen-activator-inhibitor type 1 (PAI-1), and platelet aggregation by closure times (CT) at the baseline and after six months. Results. Baseline NT-proBNP ≥ 200 pmol/mL was observed in 48.1% of the patients, EF < 55% in 49.1%, and PAI-1 ≥ 3.5 U/mL in 32.7%. Six-month treatment with ramipril or losartan resulted in a similar effect upon PAI-1, NT-proBNP, EF, and CT levels in survivors of STEMI, but in comparison to control group, receiving DAPT alone, ramipril or losartan treatment with DAPT significantly increased mean CT (226.7 ± 80.3 sec versus 158.1 ± 80.3 sec, p < 0.05). Conclusions. Ramipril and losartan exert a similar effect upon markers of heart failure and endogenous fibrinolysis, and, with DAPT, a more efficient antiplatelet effect in long term than DAPT alone.
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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. Am J Cardiol 2015; 116:865-71. [PMID: 26183794 DOI: 10.1016/j.amjcard.2015.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 11/24/2022]
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.
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Velders MA, Wallentin L, Becker RC, van Boven AJ, Himmelmann A, Husted S, Katus HA, Lindholm D, Morais J, Siegbahn A, Storey RF, Wernroth L, James SK. Biomarkers for risk stratification of patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: Insights from the Platelet Inhibition and Patient Outcomes trial. Am Heart J 2015; 169:879-889.e7. [PMID: 26027627 DOI: 10.1016/j.ahj.2015.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND The incremental prognostic value of admission measurements of biomarkers beyond clinical characteristics and extent of coronary artery disease (CAD) in patients treated with primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is unclear. METHODS Centrally analyzed plasma for biomarker measurements was available in 5,385 of the STEMI patients treated with PPCI in the PLATO trial. Extent of CAD was graded by operators in association with PPCI. We evaluated the prognostic value of high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15) beyond clinical characteristics and extent of CAD using Cox proportional hazards analyses, C-index, and net reclassification improvement (NRI). Outcomes were cardiovascular death (CVD) and spontaneous myocardial infarction (MI). RESULTS Angiographic data on extent of CAD improved the prediction of CVD compared to clinical risk factors alone, increasing the C-index from 0.760 to 0.778, total NRI of 0.31. Biomarker information provided additional prognostic value for CVD beyond clinical risk factors and extent of CAD, C-indices ranging from 0.792 to 0.795 for all biomarkers, but with a higher NRI for NT-proBNP. Extent of CAD and high-sensitivity cardiac troponin T were not associated with spontaneous MI. The prediction of spontaneous MI beyond clinical characteristics and extent of CAD (C-index 0.647) was improved by both NT-proBNP (C-index 0.663, NRI 0.22) and GDF-15 (C-index 0.652, NRI 0.05). CONCLUSIONS Biomarker measurement on admission is feasible and provides incremental risk stratification in patients with STEMI treated with PPCI, with NT-proBNP and GDF-15 being most valuable due to the association with both CVD and spontaneous MI.
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Affiliation(s)
- Matthijs A Velders
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung and Vascular Institute, Academic Health Center, Cincinnati, OH
| | - Adrianus J van Boven
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Steen Husted
- Medical Department, Hospital Unit West, Herning/Holstebro, Denmark
| | - Hugo A Katus
- Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Daniel Lindholm
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Agneta Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Lisa Wernroth
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Liu Y, He YT, Tan N, Chen JY, Liu YH, Yang DH, Huang SJ, Ye P, Li HL, Ran P, Duan CY, Chen SQ, Zhou YL, Chen PY. Preprocedural N-terminal pro-brain natriuretic peptide (NT-proBNP) is similar to the Mehran contrast-induced nephropathy (CIN) score in predicting CIN following elective coronary angiography. J Am Heart Assoc 2015; 4:jah3929. [PMID: 25888371 PMCID: PMC4579954 DOI: 10.1161/jaha.114.001410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND N-terminal pro-brain natriuretic peptide (NT-proBNP) has been associated with important risk factors for contrast-induced nephropathy (CIN). However, few studies have investigated the predictive value of NT-proBNP itself. This study investigated whether levels of preprocedural NT-proBNP could predict CIN after elective coronary angiography as effectively as the Mehran CIN score. METHODS AND RESULTS We retrospectively observed 2248 patients who underwent elective coronary angiography. The predictive value of preprocedural NT-proBNP for CIN was assessed by receiver operating characteristic and multivariable logistic regression analysis. The 50 patients (2.2%) who developed CIN had higher Mehran risk scores (9.5 ± 5.1 versus 4.8 ± 3.8), and higher preprocedural levels of NT-proBNP (5320 ± 7423 versus 1078 ± 2548 pg/mL, P<0.001). Receiver operating characteristic analysis revealed that NT-proBNP was not significantly different from the Mehran CIN score in predicting CIN (C=0.7657 versus C=0.7729, P=0.8431). An NT-proBNP cutoff value of 682 pg/mL predicted CIN with 78% sensitivity and 70% specificity. Multivariable analysis suggested that, after adjustment for other risk factors, NT-proBNP >682 pg/mL was significantly associated with CIN (odds ratio: 4.007, 95% CI: 1.950 to 8.234; P<0.001) and risk of death (hazard ratio: 2.53; 95% CI: 1.49 to 4.30; P=0.0006). CONCLUSIONS Preprocedural NT-proBNP >682 pg/mL was significantly associated with the risk of CIN and death. NT-proBNP, like the Mehran CIN score, may be another useful and rapid screening tool for CIN and death risk assessment, identifying subjects who need therapeutic measures to prevent CIN.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Yi-ting He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.) Department of Cardiology, The First People's Hospital of Shunde, Foshan, China (Y.H.)
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Yuan-hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Da-hao Yang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Shui-jin Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Piao Ye
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Hua-long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Peng Ran
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Chong-yang Duan
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.D., S.C., P.Y.C.)
| | - Shi-qun Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.D., S.C., P.Y.C.)
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., Y.H., N.T., J.C., Y.L., D.Y., S.J.H., P.Y., H.L., P.R., Y.Z.)
| | - Ping-yan Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.D., S.C., P.Y.C.)
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Kurtul A, Duran M, Yarlioglues M, Murat SN, Demircelik MB, Ergun G, Acikgoz SK, Sensoy B, Cetin M, Ornek E. Association between N-terminal pro-brain natriuretic peptide levels and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Clin Cardiol 2014; 37:485-92. [PMID: 24805995 DOI: 10.1002/clc.22291] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/05/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after percutaneous coronary intervention (PCI). Patients with acute coronary syndrome (ACS) are at higher risk for CIN. N-terminal pro-brain natriuretic peptide (NT-proBNP) is closely linked to the prognosis as a strong predictor of both short- and long-term mortality in patients with ACS. HYPOTHESIS We hypothesized that NT-proBNP levels on admission can predict the development of CIN after PCI for ACS. METHODS A total of 436 patients (age 62.27 ± 13.01 years; 64.2% male) with ACS undergoing PCI enrolled in this study. Admission NT-proBNP levels were measured before PCI. Serum creatinine values were measured before and within 72 hours after the administration of contrast agents. Patients were divided into 2 groups: CIN group and no-CIN group. CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after contrast administration. RESULTS CIN developed in 63 patients (14.4%). Baseline NT-proBNP levels were significantly higher in patients who developed CIN compared to those who did not develop CIN (median 774 pg/mL, interquartile range 177.4-2184 vs median 5159 pg/mL, interquartile range 2282-9677, respectively; P < 0.001). Multivariate analysis found that NT-proBNP (odds ratio [OR]: 3.448, 95% confidence interval [CI]: 1.394-8.474, P = 0.007) and baseline creatinine (OR: 6.052, 95% CI: 1.860-19.686, P = 0.003) were independent predictors of CIN. CONCLUSIONS Admission NT-proBNP level is an independent predictor of the development of CIN after PCI in ACS.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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Jarai R, Dangas G, Huber K, Xu K, Brodie BR, Witzenbichler B, Metzger DC, Radke PW, Yu J, Claessen BE, Genereux P, Mehran R, Stone GW. B-type Natriuretic Peptide and Risk of Contrast-Induced Acute Kidney Injury in Acute ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2012. [DOI: 10.1161/circinterventions.112.972356] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rudolf Jarai
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - George Dangas
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Kurt Huber
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Ke Xu
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Bruce R. Brodie
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Bernhard Witzenbichler
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - D. Christopher Metzger
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Peter W. Radke
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Jennifer Yu
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Bimmer E. Claessen
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Philippe Genereux
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Roxana Mehran
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
| | - Gregg W. Stone
- From the 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria (R.J., K.H.); Mount Sinai Medical Center, New York, NY (G.D., J.Y., R.M.); Cardiovascular Research Foundation, New York, NY (G.D., K.X., B.E.C., P.G., R.M., G.W.S.); LeBauer Cardiovascular Research Foundation, Greensboro, NC (B.R.B.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Lübeck University, Lübeck, Germany (P.W.R
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Amino-Terminal Pro–B-Type Natriuretic Peptide (NT-proBNP) Levels 3 Months After Myocardial Infarction Are More Strongly Associated With Magnetic Resonance–Determined Ejection Fraction Than NTproBNP Levels in the Acute Phase. J Card Fail 2011; 17:479-86. [DOI: 10.1016/j.cardfail.2011.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 02/08/2011] [Accepted: 02/24/2011] [Indexed: 11/21/2022]
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Prediction of cardiogenic shock using plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations in ST elevation myocardial infarction: An analysis from the ASSENT-4 Percutaneous Coronary Intervention Trial. Crit Care Med 2010; 38:1793-801. [DOI: 10.1097/ccm.0b013e3181eaaf2a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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