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High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients

Hoher BNP-Spiegel als Risikofaktor für akutes Nierenversagen und Prädiktor der Gesamtmortalität bei STEMI-Patienten

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Abstract

Objectives

The aim of this study was to evaluate the predictive value of brain natriuretic peptide (BNP) in the development of acute kidney injury (AKI) and 6-month all-cause mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a modest-risk population.

Background

The prognostic value of BNP has been well documented in patients with acute coronary syndrome. However, its value in development of AKI and 6-month all-cause mortality in patients with STEMI undergoing primary PCI remains unclear.

Methods

We prospectively enrolled 424 consecutive STEMI patients (mean age 53.6 ± 12.1 years) undergoing primary PCI. The population was divided into two groups: a high (n = 110) and a low (n = 314) admission BNP group according to the cut-off value (> 88.7 pg/ml) determined by ROC analysis to have the best predictive accuracy for 6-month all-cause mortality. The clinical characteristics as well as the in-hospital and 6-month outcomes of patients undergoing primary PCI were analyzed.

Results

Cox multivariate analysis showed that a high-admission BNP value (> 88.7 pg/ml) was an independent predictor of AKI development (odds ratio, 1.002; 95 % confidence interval, 1.000–1.003; p = 0.02) and 6-month all-cause mortality (odds ratio, 1.003; 95 % confidence interval; 1.001–1.004; p = 0.004).

Conclusion

These results suggest that a high-admission BNP level is associated with an increased risk of AKI development and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.

Zussamenfassung

Ziel

Ziel der vorliegenden Studie war es, den prädiktiven Wert des BNP („ brain natriuretic peptide“) für die Entwicklung eines akuten Nierenversagens und der Gesamtmortalität innerhalb von 6 Monaten nach primärer perkutaner koronarer Intervention (PCI) bei ST-Strecken-Hebungs-Infarkt (STEMI) in einer Stichprobe mit mäßiggradigem Risiko zu untersuchen.

Hintergrund

Der prognostische Wert des BNP ist bei Patienten mit akutem Koronarsyndrom gut dokumentiert. Sein Wert für die Entwicklung eines akuten Nierenversagens und der Gesamtmortalität innerhalb von 6 Monaten bei Patienten mit STEMI und primärer PCI bleibt jedoch unklar.

Methoden

Prospektiv in die Studie aufgenommen wurden 424 konsekutive STEMI-Patienten (Durchschnittsalter: 53,6 ± 12,1 Jahre), bei denen eine primäre PCI erfolgte. Die Stichprobe wurde in 2 Gruppen aufgeteilt, eine (n = 110) mit hohem und eine (n = 314) mit niedrigem BNP-Wert bei Aufnahme, entsprechend dem Grenzwert (> 88,7 pg/ml), der durch ROC-Analyse bestimmt wurde und die beste prädiktive Genauigkeit für die Gesamtmortalität innerhalb von 6 Monaten aufweist. Untersucht wurden klinische Merkmale und die Ergebnisse einer primären PCI zum Zeitpunkt des stationären Aufenthalts sowie nach 6 Monaten.

Ergebnisse

In der multivariaten Cox-Analyse erwies sich ein hoher BNP-Wert bei Aufnahme (> 88,7 pg/ml) als unabhängiger Prädiktor der Entwicklung eines akuten Nierenversagens (Odds Ratio: 1,002; 95 %-Konfidenzintervall: 1,000–1,003; p = 0,02) und der Gesamtmortalität innerhalb von 6 Monaten (Odds Ratio: 1,003; 95 %-Konfidenzintervall: 1,001–1,004; p = 0,004).

Schlussfolgerungen

Diesen Ergebnissen zufolge ist ein hoher BNP-Wert bei Aufnahme mit einem erhöhten Risiko der Entwicklung eines akuten Nierenversagens sowie der Gesamtmortalität innerhalb von 6 Monaten bei Patienten mit STEMI, bei denen eine primäre PCI erfolgt, vergesellschaftet.

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References

  1. Wiese S, Breyer T, Dragu A et al (2000) Gene expression of brain natriuretic peptide in isolated atrial and ventricular human myocardium: influence of angiotensin II and diastolic fiber length. Circulation 102:3074–3079

    Article  CAS  PubMed  Google Scholar 

  2. Arakawa N, Nakamura M, Aoki H, Hiramori K (1996) Plasma brain natriuretic peptide concentrations predict survival after acute myocardial infarction. J Am Coll Cardiol 27:1656–1661

    Article  CAS  PubMed  Google Scholar 

  3. Richards AM, Nicholls MG, Espiner EA et al (2003) B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 107:2786–2792

    Article  CAS  PubMed  Google Scholar 

  4. Zijlstra F, Hoorntje JCA, De Boer MJ et al (1999) Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 341:1413–1419

    Article  CAS  PubMed  Google Scholar 

  5. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20

    Article  PubMed  Google Scholar 

  6. Sadeghi HM, Stone GW et al (2003) Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 108:2769–2775

    Article  PubMed  Google Scholar 

  7. Marenzi G, Lauri G, Assanelli E et al (2004) Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 44:1780–1785

    Article  PubMed  Google Scholar 

  8. Schiller NB, Shah PM, Crawford M et al (1989) Recommendations for quantitation of the left ventricle by twodimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two- Dimensional Echocardiograms. J Am Soc Echocardiogr 2:358–367

    Article  CAS  PubMed  Google Scholar 

  9. Stevens LA, Coresh J, Greene T, Levey AS (2006) Assessing kidney function measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483

    Article  CAS  PubMed  Google Scholar 

  10. Schröder R (2004) Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation 110:506–510

    Article  Google Scholar 

  11. Chesebro JH, Knatterud G, Roberts R et al (1987) Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 76:142–154

    Article  CAS  PubMed  Google Scholar 

  12. Killip T, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  13. Molitoris BA, Levin A, Warnock D et al (2007) Improving outcomes of acute kidney injury: report of an initiative. Nat Clin Pract Nephrol 3(8):439–442

    Article  PubMed  Google Scholar 

  14. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction (2007) Universal definition of myocardial infarction. J Am Coll Cardiol 50(22):2173–2195

    Article  PubMed  Google Scholar 

  15. Sabatine MS, Morrow DA, Lemos JA de et al (2004) Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol 44:1988–1995

    Article  CAS  PubMed  Google Scholar 

  16. Staub D, Nusbaumer C, Zellweger MJ et al (2006) Use of B-type natriuretic peptide in the detection of myocardial ischemia. Am Heart J 151:1223–1230

    Article  CAS  PubMed  Google Scholar 

  17. Omland T, Sabatine MS, Jablonski KA et al (2007) Prognostic value of B-type natriuretic peptides in patients with stable coronary artery disease: the PEACE Trial. J Am Coll Cardiol 50:205e14

    Article  Google Scholar 

  18. Grabowski M, Filipiak KJ, Karpinski G et al (2004) Serum B-type natriuretic peptide levels on admission predict not only short-term death but also angiographic success of procedure in patients with acute ST-elevation myocardial infarction treated with primary angioplasty. Am Heart J 148:655–662

    Article  CAS  PubMed  Google Scholar 

  19. Weber M, Bazzino O, Estrada JLN et al (2008) N-terminal B-type natriuretic peptide assessment provides incremental prognostic information in patients with acute coronary syndromes and normal troponin T values upon admission. J Am Coll Cardiol 51:1188–1195

    Article  CAS  PubMed  Google Scholar 

  20. Bassan R, Tura BR, Maisel AS (2009) B-type natriuretic: a strong predictor of early and late mortality in patients with acute chest pain without ST-segment elevation in the Emergency Department. Coron Artery Dis 20:143–149

    Article  PubMed  Google Scholar 

  21. Visner MS, Arentzen CE, Parrish DG et al (1985) Effects of global ischemia on the diastolic properties of the left ventricle in the conscious dog. Circulation 71:610e19

    Article  Google Scholar 

  22. Goetze JP, Christoffersen C, Perko M et al (2003) Increased cardiac BNP expression associated with myocardial ischemia. FASEB J 17:1105–1107

    CAS  PubMed  Google Scholar 

  23. Vergés B, Zeller M, Desgrés J et al (2005) High plasma N-terminal pro-brain natriuretic peptide level found in diabetic patients after myocardial infarction is with an increased risk of in hospital mortality and cardiogenic shock. Eur Heart J 26:1734–1741

    Article  PubMed  Google Scholar 

  24. Lemos JA, Morrow DA, Bentley JH (2001) The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 345:1014–1021

    Article  PubMed  Google Scholar 

  25. Nagaya N, Nishikimi T, Goto Y et al (1998) Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction. Am Heart J 135:21–28

    Article  CAS  PubMed  Google Scholar 

  26. Morrow DA, Lemos JA de, Sabatine MS et al (2003) Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18. J Am Coll Cardiol 41:1264–1272

    Article  CAS  PubMed  Google Scholar 

  27. Barrett BJ, Parfrey PS (2006) Clinical practice: preventing nephropathy induced by contrast medium. N Engl J Med 354:379–386

    Article  CAS  PubMed  Google Scholar 

  28. McCullough PA, Wolyn R, Rocher LL et al (1997) Acute renal failure after coronary intervention: incidence, risk factors and relationship to mortality. Am J Med 103:368–375

    Article  CAS  PubMed  Google Scholar 

  29. Duan SB, Wang YH, Liu FY et al (2009) The protective role of Telmisartan against nephrotoxicity induced by X-ray contrast media in rat model. Acta Radiol 50:754–759

    Article  PubMed  Google Scholar 

  30. Winton FR (1931) The influence of venous pressure on the isolated mammalian kidney. J Physiol 72:49–61

    CAS  PubMed Central  PubMed  Google Scholar 

  31. Damman K, Deursen VM van, Navis G et al (2009) Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 53:582–588

    Article  PubMed  Google Scholar 

  32. Damman K, Navis G, Smilde TD et al (2007) Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail 9:872–878

    Article  PubMed  Google Scholar 

  33. Damman K, Voors AA, Hillege HL et al (2010) Congestion in chronic systolic heart failure is related to renal dysfunction and increased mortality. Eur J Heart Fail 12:974–982

    Article  PubMed  Google Scholar 

  34. Mullens W, Abrahams Z, Francis GS et al (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589–596

    Article  PubMed Central  PubMed  Google Scholar 

  35. Patel UD, Garg AX, Krumholz HM et al (2012) Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery. Circulation 125:1347–1355

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, KA-Green sitesi E blok/Daire: 23, 34303, Kucukcekmece, Istanbul, Turkey

    O. Akgul MD, H. Pusuroglu, S. Turen, M. Erturk, O. Surgit, O. Celik, E. Oner, A. Birant, I.F. Akturk  & N. Uslu

  2. Department of Cardiology, Bezmialem Vakıf University, School of Medicine, Istanbul, Turkey

    H. Uyarel

  3. Department of Biochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey

    N. Isiksacan

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  1. O. Akgul MD
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Akgul, O., Uyarel, H., Pusuroglu, H. et al. High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients. Herz 39, 507–514 (2014). https://doi.org/10.1007/s00059-013-3853-8

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  • DOI: https://doi.org/10.1007/s00059-013-3853-8

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