Open AccessHemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis
Author(s) -
Young James B.,
Cheng Mei,
Mills Roger M.
Publication year - 2009
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20620
Subject(s) - medicine , nesiritide , heart failure , pulmonary wedge pressure , concomitant , cardiology , hazard ratio , diuretic , population , confidence interval , natriuretic peptide , environmental health
Hypothesis Hypotension has been proposed as the cause of nesiritide‐associated increases in serum creatinine (SCr); however, this hypothesis has not been tested. Methods This retrospective evaluation of patients who had a pulmonary artery catheter and received nesiritide in the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial assessed hypotension, SCr elevation, concomitant therapy, and mortality. Patients were categorized by baseline pulmonary capillary wedge pressure (PCWP) and analyzed both for overall population and by diuretic dose. Results Compared with patients with PCWP > 23 mm Hg (n = 105), patients with PCWP ≤ 23 mm Hg (n = 49) had more hypotension within 24 hours of initiating nesiritide (16% vs 7%), but neither more SCr elevation by nominal day 30 (29% vs 28%) nor higher mortality (30 days: 8.2% vs 7.7%; 6 months: 29.0% vs 29.3%). The risk of hypotension was directly related to high dose diuretics (25% vs 6%; relative risk [RR]: 4.2; 95% confidence interval [CI]: 1.10–15.82) and was not significantly increased in patients without this concomitant treatment (10% vs 7%; RR: 1.4; 95% CI: 0.34–5.93). Additionally, high dose diuretics significantly increased the risk of SCr elevation (RR: 2.6; 95% CI: 1.03–6.64) and 6 month mortality (hazard ratio: 3.6; 95% CI: 1.19–10.63) in patients with PCWP ≤ 23 mm Hg. Conclusions Hypotension is not the primary etiology for nesiritide‐associated increases in SCr. High dose diuretics increase the risk of adverse outcomes in patients with PCWP ≤ 23 mm Hg and should be reserved for patients in whom PCWPs are known to be markedly elevated. Copyright © 2009 Wiley Periodicals, Inc.