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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Copeptin&#44; the C-terminal part of pro-arginine vasopressin&#44; has been extensively analyzed in different settings as a marker of acute severe biological stress&#44; and has been linked to worse heart- and kidney-related clinical outcomes&#46;<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>&#44; 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 &#40;PCI&#41; and found an association between copeptin levels and contrast-induced nephropathy &#40;CIN&#41; in patients with ST-elevation myocardial infarction &#40;STEMI&#41;&#46; They conclude that copeptin level at hospital admission has added value as an independent predictor of CIN&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In an era when older and sicker patients&#44; with more complex heart disease&#44; are being treated percutaneously with more complex procedures&#44; it is fair to assume that more contrast media will be used&#46; Even if currently available contrast media are safer than previous types&#44; in older patients with glomerular filtration rate below 40 ml&#47;min&#44; CIN should be always an important concern for every interventionalist&#46; It can affect as many as 25&#37; of STEMI patients treated with primary PCI&#44;<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&#44;<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&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;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&#44; whether diagnostic or therapeutic&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical value of Yildirim and Cabbar&#39;s results in preventing CIN in the setting of STEMI is doubtful&#44; 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&#44; regardless of previous blood marker results&#44; which are usually not available&#46; 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&#44; as in the current controversy surrounding multivessel PCI in STEMI&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> in which it could lead to safer procedures&#44; postponing non-culprit multivessel PCI&#44; if possible&#46;</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&#46; It is reasonable to assume that they may&#44; although further research is certainly needed&#46; In such scenarios&#44; upfront knowledge of an increased risk for CIN could be an important factor in the decision-making process&#44; avoiding further acute kidney injury and CIN&#44; as the real incidence of CIN in these patients may be underestimated due to the fact that they are discharged early&#44; long before the 3-4 day peak incidence of CIN&#46;<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&#46; Whether it has a better performance than the current score by Mehran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> is still unknown&#44; but is certainly simpler&#44; a good predictor of adherence by interventionalists&#46;</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&#46;</p></span></span>"
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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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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Copeptin&#44; the C-terminal part of pro-arginine vasopressin&#44; has been extensively analyzed in different settings as a marker of acute severe biological stress&#44; and has been linked to worse heart- and kidney-related clinical outcomes&#46;<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>&#44; 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 &#40;PCI&#41; and found an association between copeptin levels and contrast-induced nephropathy &#40;CIN&#41; in patients with ST-elevation myocardial infarction &#40;STEMI&#41;&#46; They conclude that copeptin level at hospital admission has added value as an independent predictor of CIN&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In an era when older and sicker patients&#44; with more complex heart disease&#44; are being treated percutaneously with more complex procedures&#44; it is fair to assume that more contrast media will be used&#46; Even if currently available contrast media are safer than previous types&#44; in older patients with glomerular filtration rate below 40 ml&#47;min&#44; CIN should be always an important concern for every interventionalist&#46; It can affect as many as 25&#37; of STEMI patients treated with primary PCI&#44;<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&#44;<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&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5&#44;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&#44; whether diagnostic or therapeutic&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical value of Yildirim and Cabbar&#39;s results in preventing CIN in the setting of STEMI is doubtful&#44; 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&#44; regardless of previous blood marker results&#44; which are usually not available&#46; 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&#44; as in the current controversy surrounding multivessel PCI in STEMI&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> in which it could lead to safer procedures&#44; postponing non-culprit multivessel PCI&#44; if possible&#46;</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&#46; It is reasonable to assume that they may&#44; although further research is certainly needed&#46; In such scenarios&#44; upfront knowledge of an increased risk for CIN could be an important factor in the decision-making process&#44; avoiding further acute kidney injury and CIN&#44; as the real incidence of CIN in these patients may be underestimated due to the fact that they are discharged early&#44; long before the 3-4 day peak incidence of CIN&#46;<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&#46; Whether it has a better performance than the current score by Mehran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> is still unknown&#44; but is certainly simpler&#44; a good predictor of adherence by interventionalists&#46;</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&#46;</p></span></span>"
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