Editorial comment
Predicting contrast-induced nephropathy in patients with acute myocardial infarction: Can it be avoided?
Previsão de nefropatia induzida por contraste em pacientes com enfarte agudo do miocárdio: pode ser evitado?
Manuel de Sousa Almeida
Unidade de Intervenção Cardiovascular, Hospital de Santa Cruz, Carnaxide, Portugal
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AUC: area under the curve.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ersin Yildirim, Ayca Turer Cabbar" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Ersin" "apellidos" => "Yildirim" ] 1 => array:2 [ "nombre" => "Ayca Turer" "apellidos" => "Cabbar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255120300330" "doi" => "10.1016/j.repc.2019.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120300330?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920300866?idApp=UINPBA00004E" "url" => "/21742049/0000003800000012/v1_202004041108/S2174204920300866/v1_202004041108/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Predicting contrast-induced nephropathy in patients with acute myocardial infarction: Can it be avoided?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "881" "paginaFinal" => "882" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Manuel de Sousa Almeida" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Manuel de Sousa" "apellidos" => "Almeida" "email" => array:1 [ 0 => "almeidams@sapo.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidade de Intervenção Cardiovascular, Hospital de Santa Cruz, Carnaxide, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Previsão de nefropatia induzida por contraste em pacientes com enfarte agudo do miocárdio: pode ser evitado?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Copeptin, the C-terminal part of pro-arginine vasopressin, has been extensively analyzed in different settings as a marker of acute severe biological stress, and has been linked to worse heart- and kidney-related clinical outcomes.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In their article published in the current issue of the <span class="elsevierStyleItalic">Journal</span>, Yildirim and Cabbar<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> hypothesized that copeptin is a sensitive biomarker to predict acute kidney injury after primary percutaneous coronary intervention (PCI) and found an association between copeptin levels and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI). They conclude that copeptin level at hospital admission has added value as an independent predictor of CIN.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In an era when older and sicker patients, with more complex heart disease, are being treated percutaneously with more complex procedures, it is fair to assume that more contrast media will be used. Even if currently available contrast media are safer than previous types, in older patients with glomerular filtration rate below 40 ml/min, CIN should be always an important concern for every interventionalist. It can affect as many as 25% of STEMI patients treated with primary PCI,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> it is the third most common cause of acute renal failure in hospitalized patients,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> and has a major impact on patient prognosis as well as on morbidity and quality of life.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,6</span></a> These reasons are sufficient to bring CIN to the forefront of our concerns every time we decide on a contrast-based procedure, whether diagnostic or therapeutic.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical value of Yildirim and Cabbar's results in preventing CIN in the setting of STEMI is doubtful, since primary PCI is an emergent procedure in which the main concern is to obtain TIMI 3 flow in the culprit lesion as soon as possible, regardless of previous blood marker results, which are usually not available. But the availability of quick results from point of care testing<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> may in the future be helpful in choosing safer treatment strategies for STEMI, as in the current controversy surrounding multivessel PCI in STEMI,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> in which it could lead to safer procedures, postponing non-culprit multivessel PCI, if possible.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The question is whether such results also apply to other clinical settings such as non-STEMI or even elective coronary procedures. It is reasonable to assume that they may, although further research is certainly needed. In such scenarios, upfront knowledge of an increased risk for CIN could be an important factor in the decision-making process, avoiding further acute kidney injury and CIN, as the real incidence of CIN in these patients may be underestimated due to the fact that they are discharged early, long before the 3-4 day peak incidence of CIN.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Yildirim and Cabbar have provided a tool to predict CIN after PPCI. Whether it has a better performance than the current score by Mehran et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> is still unknown, but is certainly simpler, a good predictor of adherence by interventionalists.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Copeptin and cardiovascular disease: a review of a novel neurohormone" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. 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| 2022 October | 21 | 26 | 47 |
| 2022 September | 21 | 39 | 60 |
| 2022 August | 17 | 26 | 43 |
| 2022 July | 21 | 38 | 59 |
| 2022 June | 23 | 24 | 47 |
| 2022 May | 18 | 26 | 44 |
| 2022 April | 22 | 32 | 54 |
| 2022 March | 24 | 45 | 69 |
| 2022 February | 27 | 36 | 63 |
| 2022 January | 15 | 30 | 45 |
| 2021 December | 20 | 30 | 50 |
| 2021 November | 22 | 34 | 56 |
| 2021 October | 33 | 49 | 82 |
| 2021 September | 19 | 26 | 45 |
| 2021 August | 22 | 33 | 55 |
| 2021 July | 18 | 26 | 44 |
| 2021 June | 23 | 26 | 49 |
| 2021 May | 28 | 48 | 76 |
| 2021 April | 31 | 26 | 57 |
| 2021 March | 25 | 20 | 45 |
| 2021 February | 29 | 14 | 43 |
| 2021 January | 24 | 13 | 37 |
| 2020 December | 22 | 12 | 34 |
| 2020 November | 16 | 18 | 34 |
| 2020 October | 24 | 15 | 39 |
| 2020 September | 15 | 14 | 29 |
| 2020 August | 11 | 6 | 17 |
| 2020 July | 10 | 12 | 22 |
| 2020 June | 10 | 7 | 17 |
| 2020 May | 18 | 16 | 34 |
| 2020 April | 57 | 25 | 82 |
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