Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr;11(4):1589-1596.
doi: 10.21037/jtd.2019.04.65.

Early β-blockers administration might be associated with a reduced risk of contrast-induced acute kidney injury in patients with acute myocardial infarction

Jin Liu  1 , Guoli Sun  2 , Yibo He  1 , Feier Song  1 , Shiqun Chen  1   3 , Zhaodong Guo  1 , Bowen Liu  2 , Li Lei  4 , Lihao He  1 , Jiyan Chen  1   2   3 , Ning Tan  1   2   3 , Yong Liu  1   2
Affiliations

Early β-blockers administration might be associated with a reduced risk of contrast-induced acute kidney injury in patients with acute myocardial infarction

Jin Liu et al. J Thorac Dis. 2019 Apr.

Abstract

Background: Contrast-induced acute kidney injury (CI-AKI) is a common complication of coronary angiography (CAG), which is associated with worse prognosis. Some studies indicated β-blockers could preserve renal function among patients with acute myocardial infarction (AMI), but the relationship between β-blockers and CI-AKI has not been well documented among patients with AMI who were undergoing CAG or percutaneous coronary intervention (PCI).

Methods: In this prospective, observational study, 1,309 AMI patients who were undergoing CAG or PCI were consecutively recruited between January 2010 and December 2013. Patients were assigned into β-blockers group (n=1,074) or non-β-blockers group (n=235) according to use or non-use of β-blockers (including metoprolol tartrate/metoprolol succinate/Bisoprolol Fumarate) within 24 hours of perioperative period. CI-AKI was defined as an absolute increase of >0.5 mg/dL from baseline serum creatinine (SCr) within 48-72 hours after contrast medium (CM) exposure.

Results: The overall incidence of CI-AKI was 247/1,309 (18.9%).After multivariate adjusting, a total of 10 variables were related to CI-AKI, including β-blockers [β-blockers group vs. non-β-blockers group: odds ratio (OR) =0.520; 95% confidence interval (CI), 0.291-0.930; P=0.027], age, diabetes mellitus, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, left ventricular ejection fraction (LVEF) <40%, use of intra-aortic balloon pump (IABP), peri-hypotension, emergent PCI, coronary lesions and CM dose >200 mL. During the mean follow-up of 2.35±0.99 years, the β-blockers group was significantly associated with lower rates of mortality [β-blockers group vs. non-β-blockers group: adjusted hazard ratio (HR) =0.43; 95% CI, 0.27-0.71; P=0.001] among patients with AMI.

Conclusions: Use of β-blockers within 24 hours of perioperative period may be associated with lower rates of CI-AKI and long-term mortality among patients with AMI who are undergoing CAG or PCI.

Trial registration: PRECOMIN, ClinicalTrials.gov NCT01400295.

Keywords: acute myocardial infarction (AMI); contrast-induced acute kidney injury (CI-AKI); coronary angiography (CAG); mortality; β-blockers.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Association between β-blockers and long-term mortality.
Figure 2
Figure 2
Cox proportional hazards regression analyses of long-term mortality. eGFR, effective glomerular filtration rate; PCI, emergency percutaneous coronary intervention; IABP, intra-aortic balloon pump; DM, diabetes mellitus; LVEF, left ventricular ejection fraction.
Figure 3
Figure 3
Association between CIN and long-term mortality. CIN, contrast-induced nephropathy.
See this image and copyright information in PMC

Comment in

References

    1. Marenzi G, Lauri G, Assanelli E, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2004;44:1780-5. 10.1016/j.jacc.2004.07.043 - DOI - PubMed
    1. Fox CS, Muntner P, Chen AY, et al. Short-term outcomes of acute myocardial infarction in patients with acute kidney injury: a report from the national cardiovascular data registry. Circulation 2012;125:497-504. 10.1161/CIRCULATIONAHA.111.039909 - DOI - PMC - PubMed
    1. Centola M, Lucreziotti S, Salerno-Uriarte D, et al. A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int J Cardiol 2016;210:4-9. 10.1016/j.ijcard.2016.02.086 - DOI - PubMed
    1. Parikh CR, Coca SG, Wang Y, et al. Long term prognosis of acute kidney injury after acute myocardial infarction. Arch Intern Med 2008;168:987-95. 10.1001/archinte.168.9.987 - DOI - PubMed
    1. Hwang SH, Jeong MH, Ahmed K, et al. Different clinical outcomes of acute kidney injury according to acute kidney injury network criteria in patients between ST elevation and non-ST elevation myocardial infarction. Int J Cardiol 2011;150:99-101. 10.1016/j.ijcard.2011.03.039 - DOI - PubMed

Associated data