Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12221-12229
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12221
Protective effect of recombinant human brain natriuretic peptide against contrast-induced nephropathy in elderly acute myocardial infarction patients: A randomized controlled trial
Yi-Jing Zhang, Lin Yin, Jun Li
Yi-Jing Zhang, Lin Yin, Jun Li, Department of Imaging, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, China
Author contributions: Zhang YJ and Li J contributed equally to this work; Zhang YJ, Yin L, and Li J gave the conception and designed the research study; Zhang YJ performed the research; Zhang YJ, Yin L, and Li J analyzed the data; Zhang YJ, Yin L, and Li J wrote the manuscript; all authors gave their final approval and agree to be accountable for all aspects of the work.
Institutional review board statement: The study protocol was approved by the Anhui Medical University Affiliated Wuxi Clinical College Clinical Research Ethics Committee (Approval No. 2016-YXLL-051).
Clinical trial registration statement: This study was registered at Hospital Clinical Trial Registry (No. WXCTR-IM-171162).
Informed consent statement: Written informed consent was obtained from the patients whose competence was established by their accurate orientation for time, place, and person, as well as an understanding of the recruiter’s description of the trial or from their next of kin or legal representative.
Conflict-of-interest statement: The authors declare that there are no conflicting interests to disclose.
Data sharing statement: The corresponding author may provide the datasets used in the study upon request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Li, BSc, Chief Nurse, Department of Imaging, 904th Hospital of Joint Logistic Support Force of PLA, No. 101 Xing Yuan North Road, Wuxi 214044, Jiangsu Province, China. sm2008@21cn.com
Received: July 17, 2022
Peer-review started: July 17, 2022
First decision: September 9, 2022
Revised: September 21, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: November 26, 2022
Processing time: 129 Days and 2.4 Hours
Abstract
BACKGROUND

Increasing reports have demonstrated that recombinant human brain natriuretic peptide (rhBNP) can improve acute myocardial infarction (AMI) and heart failure. However, whether it can improve renal function and decrease the risk of contrast-induced nephropathy (CIN) in elderly AMI patients is still unclear.

AIM

To explore the effect of rhBNP on CIN in elderly AMI patients after percutaneous coronary intervention (PCI).

METHODS

One hundred and thirty-one elderly AMI patients underwent PCI from January 2017 to July 2021. Patients were either given 1 mL of 0.9% normal saline/(kg/h) for 72 h after PCI (control group, n = 66) and or intravenous rhBNP [1.5 mg/kg followed by 0.0075 mg/(kg/min)] for 72 h (rhBNP treatment group, n = 65). Serum creatinine and cystatin C levels, creatinine clearance rate, and eGFR were measured at 24 h, 48 h, and 72 h after PCI. Research nurses collected data on handwritten forms, and then stored them in password-protected electronic databases.

RESULTS

The creatinine clearance rate and eGFR were increased, while the creatinine and cystatin C levels were decreased significantly in the rhBNP treatment group compared to the control group at 48 h and 72 h. The incidence of CIN (P = 0.028) and acute heart failure (P = 0.017) also significantly decreased in the rhBNP group. No significant difference was noted between the two groups in cardiac death and recurrent AMI.

CONCLUSION

Early application of rhBNP could protect renal function and decrease the incidence of CIN after primary PCI and acute heart failure.

Keywords: Natriuretic peptide, Myocardial infarction, Contrast media, Acute myocardial infarction, Percutaneous coronary intervention

Core Tip: Increasing evidence indicates that emergency percutaneous coronary intervention (PCI) is the most effective method for the treatment of acute myocardial infarction (AMI). However, with the increase of emergency PCI, contrast-induced nephropathy (CIN) is becoming more and more common, which also leads to the increase of the proportion of patients with renal dysfunction, aggravating the cost of hospitalization and prolonging the length of hospital stay. CIN cannot be managed or prevented with current medications. Recombinant human B-type natriuretic peptide (rhBNP) is the natriuretic peptide receptor A, and increasing reports have demonstrated that rhBNP can improve AMI and heart failure. However, whether it can improve renal function and decrease the risk of CIN in elderly patients is still unclear. In this study, we explored the effectiveness of rhBNP treatment in postoperative CIN in elderly AMI patients. We found that early application of rhBNP after primary PCI could protect renal function, reduce serum creatinine and cystatin C levels, improve creatinine clearance rate, and decrease the risk of CIN and acute heart failure in AMI patients. We showed rhBNP as an effective drug to prevent CIN in the elderly after PCI.