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

Study Questions:

What is the predictive ability of admission B-type natriuretic peptide (BNP) levels on the development of contrast-induced acute kidney injury (CI-AKI)?


A total of 979 ST-segment elevation myocardial infarction (STEMI) patients enrolled in the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial had BNP levels measured in the emergency room prior to primary percutaneous coronary intervention (PCI) 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 (1.31 [1.14, 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 = 0.156; p < 0.001), and to the Mehran Risk Score (net reclassification improvement = 0.100; p = 0.015).


The authors concluded that measurement of serum BNP at hospital admission may help identify patients who are at risk for developing CI-AKI after primary PCI in STEMI.


This substudy from the HORIZONS-AMI trial suggests that measurement of BNP levels at admission was strongly related to the development of CI-AKI in patients with STEMI undergoing primary PCI, and provided complementary prognostic information to other known clinical and laboratory-based predictors of CI-AKI. Randomized trials are indicated to determine whether this knowledge prior to contrast administration may be used for application of therapeutic measures to prevent CI-AKI. For now, admission BNP concentrations could be used in conjunction with clinical and other laboratory parameters to identify patients at risk of CI-AKI, and to target them for appropriate measures such as hydration and minimizing contrast use.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Prognosis, Natriuretic Peptides, Myocardial Infarction, Biological Markers, Acute Kidney Injury, Hospitalization, Logistic Models, Stents, Percutaneous Coronary Intervention

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