Baseline nt-probnp level as a risk predictor of contrast induced-acute kidney injury in acute coronary syndrome patients undergoing primary angioplasty

Introduction: Contrast Induced Acute Kidney Injury (CI-AKI) is a common complication of invasive cardiovascular procedures. A three-fold higher risk of developing CI-AKI has been observed in patients with Acute Coronary Syndrome (ACS) who undergo Percutaneous Coronary Intervention (PCI). Several risk score models reflecting the cumulative risk of several peri-procedural predictors, such as the Mehran CIN score and Battle Management Command and Control (BMC2) CIN score, have been established and proven. Recent data suggest that baseline NT-proBNP may help to identify ST-Elevation Mycardial Infraction (STEMI) patients at risk for CI-AKI after primary PCI. Aim: The aim of the present was to prognosticate ACS patients treated with Primary PCI for the risk of developing CI-AKI by correlating it with pre procedural NT-proBNP levels. Materials and Methods: The present study was a prospective cross-sectional observational study, involving 150 patients with ACS undergoing PCI at Kasturba Medical College, Manipal, Karnataka, India (January 2016 to December 2016). Patients with ACS (STEMI and NSTEMI) who underwent primary PCI were included in the study. Pre-existing renal derangement, acute left ventricular failure and cardiogenic shock patients were excluded from the present study. Continuous variables were described as mean±standard deviation and compared by using the t-test or Wilcoxon rank-sum test. Categorical variables are described in terms of frequency and percentage and compared using the Chi-square or Fisher exact test. The Receiver Operating Characteristic (ROC) curves, paired sample t-test and independent t-test were applied for further analysis. Results: A total of 150 patients (mean age, 63.03±9.07 years and 64.3% male) were included in the study. Among the study 22 (14.6%) patients developed CI-AKI. The value of NT-proBNP at presentation was significantly higher in patients who developed CI-AKI compared to those who did not (p<0.001). A cut off value of NT-proBNP of ≥2320 pg/mL as measured on admission has 90.9% sensitivity and 81.5% specificity in predicting CI-AKI. Conclusion: Higher Baseline NT-proBNP levels (with a cut off value of 2620.46 pg/mL) can predict the development of CI-AKI after Percutaneous Transluminal Coronary Angioplasty (PTCA) in patient with ACS.