Analysis of biomarkers for risk of acute kidney injury after primary angioplasty for acute ST-segment elevation myocardial infarction: results of the HORIZONS-AMI trial.

Abstract

OBJECTIVES:

Contrast-induced acute kidney injury (CI-AKI) may occur after percutaneous coronary intervention (PCI).

METHODS:

We evaluated patients with ST-elevation myocardial infarction (STEMI) undergoing emergency PCI with serial biomarkers.

RESULTS:

Of the 390 patients enrolled in the HORIZONS-AMI biomarker substudy, 56 (14.3%) developed AKI. In the AKI group, the levels of B-type natriuretic peptide were consistently higher than in the no-AKI group at baseline (P = 0.0327), hospital discharge (P = 0.0002), 30-day follow-up (P = 0.0193), and 1-year follow-up (P = 0.031). At hospital discharge, the AKI group had elevated biomarkers compared to the no-AKI group: D-dimer (P = 0.0066), C-reactive protein (P = 0.0468), endothelial cell-selective adhesion molecule (P = 0.0169), adiponectin (P = 0.0346), and von Willebrand factor (P = 0.0168); there was also a trend toward higher cystatin C (P = 0.0585) in the AKI group. Similar correlations between biomarker panel increase and the development of CI-AKI were consistent at baseline, 30-day, and 1-year follow-up. Chemokine (C-C motif) ligand 23 showed an opposite pattern with an increase at all time points in the no-AKI compared to the AKI group.

CONCLUSIONS:

The risk of CI-AKI after primary PCI for STEMI may be associated with hemostatic imbalances, activation of procoagulants, decreased endogenous anticoagulants, enhanced inflammation, platelet activation, or decreased fibrinolytic activity.

• Authors: Alejandra Guerchicoff, Gregg W Stone, Roxana Mehran, Ke Xu, Dru Nichols, Bimmer E Claessen, Giulio Guagliumi, Bernhard Witzenbichler, José P S Henriques, George D Dangas
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 85 Issue 3 Pg. 335-42 (Feb 15 2015) ISSN: 1522-726X [Electronic] United States
• PMID: 25130788 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Wiley Periodicals, Inc.

Chemical References

• Biomarkers
• Contrast Media
• Inflammation Mediators

Topics

• Acute Kidney Injury (blood, diagnosis, etiology)
• Aged
• Angioplasty, Balloon, Coronary (adverse effects)
• Biomarkers (blood)
• Blood Coagulation
• Contrast Media (adverse effects)
• Emergencies
• Female
• Fibrinolysis
• Humans
• Inflammation Mediators (blood)
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnosis, therapy)
• Platelet Activation
• Risk Factors
• Time Factors
• Treatment Outcome
• Up-Regulation