Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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?

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Senoo T, Motohiro M, Kamihata H, Yamamoto S, Isono T, Manabe K, Sakuma T, Yoshida S, Sutani Y, Iwasaka T (2010) Contrast-induced nephropathy in patients undergoing emergency percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol 105:624–628

  2. 2.

    Wi J, Ko YG, Kim JS, Kim BK, Choi D, Ha JW, Hong MK, Jang Y (2011) Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart 97:1753–1757

  3. 3.

    Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, Kosiborod M, Amin AP, Messenger JC, Rumsfeld JS, Spertus JA (2014) Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: insights From the NCDR Cath-PCI Registry. JACC Cardiovasc Interv 7:1–9

  4. 4.

    Firouzi A, Maadani M, Kiani R, Shakerian F, Sanati HR, Zahedmehr A, Nabavi S, Heidarali M (2015) Intravenous magnesium sulfate: new method in prevention of contrast-induced nephropathy in primary percutaneous coronary intervention. Int Urol Nephrol 47:521–525

  5. 5.

    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 (2012) 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. Circ Cardiovasc Interv 5:813–820

  6. 6.

    Moltrasio M, Cabiati A, Milazzo V, Rubino M, De Metrio M, Discacciati A, Rumi P, Marana I, Marenzi G (2014) B-type natriuretic peptide and risk of acute kidney injury in patients hospitalized with acute coronary syndromes. Crit Care Med 42:619–624

  7. 7.

    Gurm HS, Seth M, Kooiman J, Share D (2013) A novel tool for reliable and accurate prediction of renal complications in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol 61:2242–2248

  8. 8.

    Liu YH, Liu Y, Tan N, Chen JY, Chen J, Chen SH, He YT, Ran P, Ye P, Li Y (2014) Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention. Int Urol Nephrol 46:417–426

  9. 9.

    Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention. J Am Coll Cardiol 44:1393–1399

  10. 10.

    Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Sparta I, Politi L, Aprile A, Amato A, Rossi R, Biondi-Zoccai G, Sangiorgi GM, Modena MG (2010) Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv 3:491–498

  11. 11.

    Wi J, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Ha JW, Hong MK, Jang Y (2013) Prediction of contrast-induced nephropathy with persistent renal dysfunction and adverse long-term outcomes in patients with acute myocardial infarction using the Mehran risk score. Clin Cardiol 36:46–53

  12. 12.

    Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, Xu JS, Huang SM, Wang LN, Huang W, Wang M, Xu GB, Wang HY (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944

  13. 13.

    Slocum NK, Grossman PM, Moscucci M, Smith DE, Aronow HD, Dixon SR, Share D, Gurm HS (2012) The changing definition of contrast-induced nephropathy and its clinical implications: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Am Heart J 163:829–834

  14. 14.

    Stacul F, van der Molen AJ, Reimer P, Webb JAW, Thomsen HS, Morcos SK, Almén T, Aspelin P, Bellin M, Clement O, Heinz-Peer G (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21:2527–2541

  15. 15.

    Demidenko E (2008) Sample size and optimal design for logistic regression with binary interaction. Stat Med 27:36–46

  16. 16.

    Jarai R, Huber K, Bogaerts K, Droogne W, Ezekowitz J, Granger CB, Sinnaeve PR, Ross AM, Zeymer U, Armstrong PW, Van de Werf FJ (2010) Plasma N-terminal fragment of the prohormone B-type natriuretic peptide concentrations in relation to time to treatment and Thrombolysis in Myocardial Infarction (TIMI) flow: a substudy of the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT IV-PCI) trial. Am Heart J 159:131–140

  17. 17.

    Jarai R, Huber K, Bogaerts K, Sinnaeve PR, Ezekowitz J, Ross AM, Zeymer U, Armstrong PW, Van de Werf FJ (2010) Prediction of cardiogenic shock using plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone [corrected] concentrations in ST elevation myocardial infarction: an analysis from the ASSENT-4 Percutaneous Coronary Intervention Trial. Crit Care Med 38:1793–1801

  18. 18.

    Patel UD, Garg AX, Krumholz HM, Shlipak MG, Coca SG, Sint K, Thiessen-Philbrook H, Koyner JL, Swaminathan M, Passik CS, Parikh CR (2012) Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery. Circulation 125:1347–1355

  19. 19.

    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 (2012) 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. Circ Cardiovasc Interv 5:813–820

  20. 20.

    Akgul O, Uyarel H, Pusuroglu H, Isiksacan N, Turen S, Erturk M, Surgit O, Celik O, Oner E, Birant A, Akturk IF, Uslu N (2014) High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients. Herz 39:507–514

  21. 21.

    van Kimmenade RR, Januzzi JJ, Bakker JA, Houben AJ, Rennenberg R, Kroon AA, Crijns HJ, van Dieijen-Visser MP, de Leeuw PW, Pinto YM (2009) Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide a mechanistic study in hypertensive subjects. J Am Coll Cardiol 53:884–890

  22. 22.

    Liu YH, Liu Y, Zhou YL, Yu DQ, He PC, Xie NJ, Li HL, Wei-Guo S, Chen JY, Tan N (2015) Association of N-terminal pro-B-type natriuretic peptide with contrast-induced nephropathy and long-term outcomes in patients with chronic kidney disease and relative preserved left ventricular function. Medicine (Baltimore) 94:e358

  23. 23.

    Kurtul A, Duran M, Yarlioglues M, Murat SN, Demircelik MB, Ergun G, Acikgoz SK, Sensoy B, Cetin M, Ornek E (2014) 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 37:485–492

  24. 24.

    Rosenstock JL, Gilles E, Geller AB, Panagopoulos G, Mathew S, Malieckal D, DeVita MV, Michelis MF (2010) Impact of heart failure on the incidence of contrast-induced nephropathy in patients with chronic kidney disease. Int Urol Nephrol 42:1049–1054

  25. 25.

    Shacham Y, Leshem-Rubinow E, Gal-Oz A, Arbel Y, Keren G, Roth A, Steinvil A (2015) Acute cardio-renal syndrome as a cause for renal deterioration among myocardial infarction patients treated with primary percutaneous intervention. Can J Cardiol 31:1240–1244

  26. 26.

    Lazzeri C, Valente S, Attana P, Chiostri M, Picariello C, Gensini GF (2013) The prognostic role of chronic obstructive pulmonary disease in ST-elevation myocardial infarction after primary angioplasty. Eur J Prev Cardiol 20:392–398

  27. 27.

    Timoteo AT, Toste A, Ramos R, Miranda F, Ferreira ML, Oliveira JA, Ferreira RC (2009) Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes? Acute Card Care 11:236–242

  28. 28.

    Correia LCL, Rocha MS, Bittencourt AP, Freitas R, Souza AC, Almeida MC, Péricles Esteves J (2009) Does acute hyperglycemia add prognostic value to the GRACE score in individuals with non-ST elevation acute coronary syndromes? Clin Chim Acta 410:74–78

  29. 29.

    Correia LCL, Andrade BB, Borges VM, Clarêncio J, Bittencourt AP, Freitas R, Souza AC, Almeida MC, Leal J, Esteves JP, Barral-Netto M (2010) Prognostic value of cytokines and chemokines in addition to the GRACE Score in non-ST-elevation acute coronary syndromes. Clin Chim Acta 411:540–545

  30. 30.

    Correia LC, Vasconcelos I, Garcia G, Kalil F, Ferreira F, Silva A, Oliveira R, Carvalhal M, Freitas C, Noya-Rabelo MM (2014) Does C-reactive protein add prognostic value to GRACE score in acute coronary syndromes? Arq Bras Cardiol 102:449–455

  31. 31.

    Fukuta H, Ohte N, Mukai S, Saeki T, Kobayashi K, Kimura G (2008) Anemia is an independent predictor for elevated plasma levels of natriuretic peptides in patients undergoing cardiac catheterization for coronary artery disease. Circ J 72:212–217

  32. 32.

    Budano C, Levis M, D’Amico M, Usmiani T, Fava A, Sbarra P, Burdese M, Segoloni GP, Colombo A, Marra S (2011) Impact of contrast-induced acute kidney injury definition on clinical outcomes. Am Heart J 161:963–971

Download references

Acknowledgments

This study was supported by a grant from the National Natural Science Foundation of China (Grant No. 81270286) and the Medjaden Academy & Research Foundation for Young Scientists (Grant No. MJR20160025). The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. The work was not funded by any industry sponsors.

Author information

Correspondence to Ning Tan.

Ethics declarations

Conflict of interest

None.

Additional information

Yuan-hui Liu and Lei Jiang are considered as the co-first author.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, Y., Jiang, L., Chen, J. et al. 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 48, 1675–1682 (2016). https://doi.org/10.1007/s11255-016-1348-2

Download citation

Keywords

  • Primary percutaneous coronary intervention
  • ST-segment elevation myocardial infarction
  • Contrast-induced nephropathy
  • N-terminal pro-brain natriuretic peptide