Atrial natriuretic peptide therapy and in-hospital mortality in acute myocardial infarction patients undergoing percutaneous coronary intervention.
BACKGROUND
Atrial natriuretic peptide (ANP) therapy has been reported to have beneficial effects in patients with acute myocardial infarction (AMI); however, its impact on in-hospital mortality remains unclear. This study aimed to investigate the effects of ANP therapy on in-hospital mortality in AMI patients undergoing percutaneous coronary intervention (PCI).


METHODS
This was a retrospective cohort study using the Diagnosis Procedure Combination inpatient database in Japan. We identified AMI patients who underwent PCI with stent implantation on the day of admission, between 2010 and 2014. We compared 30-day in-hospital mortality between patients who started ANP therapy on the day of admission (ANP group) and those who received no ANP therapy during hospitalization (control group), using propensity score and instrumental variable methods.


RESULTS
Of 60,592 eligible patients (8189 ANP group, 52,403 control group) from 850 hospitals, 1:1 propensity score matching created 8027 pairs. There was no significant difference in 30-day in-hospital mortality between the ANP and control groups (3.4% vs. 3.8%, respectively; p=0.162; risk difference, -0.42%; 95% confidence interval [CI], -1.00% to 0.15%) in the propensity score-matched cohort. Logistic regression analysis with adjustment for propensity score deciles found no significant association between ANP therapy and 30-day in-hospital mortality (odds ratio, 0.99; 95% CI, 0.82 to 1.19). Instrumental variable analysis also showed no significant association between ANP therapy and 30-day in-hospital mortality (risk difference, -0.59%; 95% CI, -1.24% to 0.05%).


CONCLUSIONS
This study found no significant association between ANP therapy and in-hospital mortality in AMI patients undergoing PCI.
['Isogai|Toshiaki|T|', 'Matsui|Hiroki|H|', 'Tanaka|Hiroyuki|H|', 'Fushimi|Kiyohide|K|', 'Yasunaga|Hideo|H|']
D000368:Aged D009320:Atrial Natriuretic Factor D015331:Cohort Studies D005260:Female D017052:Hospital Mortality D006801:Humans D007564:Japan D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D010043:Outcome and Process Assessment, Health Care D062645:Percutaneous Coronary Intervention D012189:Retrospective Studies D013223:Statistics as Topic D014665:Vasodilator Agents
Atrial natriuretic peptide In-hospital mortality Acute myocardial infarction Percutaneous coronary intervention