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).
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.
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.
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.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Demidenko E (2008) Sample size and optimal design for logistic regression with binary interaction. Stat Med 27:36–46
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
Conflict of interest
Yuan-hui Liu and Lei Jiang are considered as the co-first author.
About this article
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
- Primary percutaneous coronary intervention
- ST-segment elevation myocardial infarction
- Contrast-induced nephropathy
- N-terminal pro-brain natriuretic peptide