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

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 ß-blockers could preserve renal function among patients with acute myocardial infarction (AMI), but the relationship between ß-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 ß-blockers group (n=1,074) or non-ß-blockers group (n=235) according to use or non-use of ß-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 ß-blockers [ß-blockers group vs. non-ß-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 ß-blockers group was significantly associated with lower rates of mortality [ß-blockers group vs. non-ß-blockers group adjusted hazard ratio (HR) =0.43; 95% CI, 0.27-0.71; P=0.001] among patients with AMI. CONCLUSIONS: Use of ß-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.