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

作者：Guerchicoff Alejandra; Stone Gregg W; Mehran Roxana; Xu Ke; Nichols Dru; Claessen Bimmer E; Guagliumi Giulio; Witzenbichler Bernhard; Henriques Jose P S; Dangas George D^*

来源：Catheterization and Cardiovascular Interventions, 2015, 85(3): 335-342.

DOI：10.1002/ccd.25620

• acute kidney injury
• angioplasty
• STEMI
• biomarkers

ObjectivesContrast-induced acute kidney injury (CI-AKI) may occur after percutaneous coronary intervention (PCI).
MethodsWe evaluated patients with ST-elevation myocardial infarction (STEMI) undergoing emergency PCI with serial biomarkers.
ResultsOf 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.
ConclusionsThe 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.

• 出版日期2015-2-15