Papers by Vicente Sánchez-Brunete
Revista Espanola De Cardiologia, Jul 1, 2011
American Heart Journal, Oct 1, 2012
Infarct size predicts post-infarction mortality. Oral β-blockade within 24 hours of a ST-segment ... more Infarct size predicts post-infarction mortality. Oral β-blockade within 24 hours of a ST-segment elevation acute myocardial infarction (STEMI) is a class-IA indication, however early intravenous (IV) β-blockers initiation is not encouraged. In recent magnetic resonance imaging (MRI)-based experimental studies, the β(1)-blocker metoprolol has been shown to reduce infarct size only when administered before coronary reperfusion. To date, there is not a single trial comparing the pre- vs. post-reperfusion β-blocker initiation in STEMI. The METOCARD-CNIC trial is testing whether the early initiation of IV metoprolol before primary percutaneous coronary intervention (pPCI) could reduce infarct size and improve outcomes when compared to oral post-pPCI metoprolol initiation. The METOCARD-CNIC trial is a randomized parallel-group single-blind (to outcome evaluators) clinical effectiveness trial conducted in 5 Counties across Spain that will enroll 220 participants. Eligible are 18- to 80-year-old patients with anterior STEMI revascularized by pPCI ≤6 hours from symptom onset. Exclusion criteria are Killip-class ≥III, atrioventricular block or active treatment with β-blockers/bronchodilators. Primary end point is infarct size evaluated by MRI 5 to 7 days post-STEMI. Prespecified major secondary end points are salvage-index, left ventricular ejection fraction recovery (day 5-7 to 6 months), the composite of (death/malignant ventricular arrhythmias/reinfarction/admission due to heart failure), and myocardial perfusion. The METOCARD-CNIC trial is testing the hypothesis that the early initiation of IV metoprolol pre-reperfusion reduces infarct size in comparison to initiation of oral metoprolol post-reperfusion. Given the implications of infarct size reduction in STEMI, if positive, this trial might evidence that a refined use of an approved inexpensive drug can improve outcomes of patients with STEMI.
Annals of Emergency Medicine, Mar 1, 2015
Circulation, Jul 15, 2014
We appreciate the interest of and comments by Drs Argulian and Messerli on our recently published... more We appreciate the interest of and comments by Drs Argulian and Messerli on our recently published study. 1 Defining inclusion and exclusion criteria, along with dose selection of the administered pharmacological therapy, is critical in the early stages of a clinical trial design. The scientific method strongly recommends performing a profound bibliographic research in this regard, and for this purpose, we carefully reviewed previously conducted trials on the use of β-blockers in the setting of ST-segment-elevation acute myocardial infarction, taking note of the strengths and weaknesses of each of them. Thus, for the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) trial, we randomized anterior myocardial infarctions revascularized by primary angioplasty in <6 hours from symptom onset because this is the population that most benefits from any cardioprotective intervention. More important, and for safety reasons, we designed a trial to recruit patients with no obvious contraindications for the administration of intravenous metoprolol. Because β-blockers are clearly contraindicated in the acute phase of severe heart failure, patients in Killip-Kimball classes III and IV were strictly excluded from randomization, 2 fulfilling the primum non nocere principle. Patients randomized to intravenous metoprolol received up to three 5-mg boluses of metoprolol tartrate 2 minutes apart, following the same scheme as that in the Thrombolysis in Myocardial Infarction (TIMI) II-B trial, 3 closely checking for the presence of contraindications-heart rhythm and rate, PR-interval duration, blood pressure, and clinical examination-before the administration of every single bolus. Similarly, the dose and timing for oral metoprolol after reperfusion were selected according to current recommendations. 4 Thus, an initial low dose of 25 mg metoprolol twice a day was initiated in the vast majority of the patients included in the trial within the first 24 hours of admission and was carefully titrated according to clinical judgment. The increase in mortality observed in patients with initial systolic blood pressure <120 mm Hg or Killip-Kimball class III in the Clopidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) trial 5 is one of the main reasons why clinical practice guidelines do not emphasize early intravenous β-blocker initiation in ST-segmentelevation myocardial infarction. These patients were systematically excluded from our trial; consequently, prereperfusion administration of intravenous metoprolol did not increase the incidence of major adverse cardiac events in our study. This reinforces the contraindications for intravenous β-blocker therapy in patients with overt heart failure but supports its use in the population that can potentially benefit most from this inexpensive, safe, and effective intervention. Although there are other important differences between the METOCARD-CNIC trial and previously conducted studies evaluating the effect of β-blockers in the setting of ST-segment-elevation acute myocardial infarction, we totally agree with Drs Argulian and Messerli that a careful design of the dose and timing of any given intervention can make a huge difference in the outcomes of a trial. Disclosures None.
Knowledge Based Systems, Nov 1, 2014
The main objective of emergency medical assistance (EMA) services is to attend patients with sudd... more The main objective of emergency medical assistance (EMA) services is to attend patients with sudden diseases at any possible location within an area of influence. This usually consists in providing "in situ" assistance and, if necessary, the transport of the patient to a medical centre. The potential of such systems to reduce mortality is directly related to the travel times of ambulances to emergency patients. An efficient coordination of the ambulance fleet of an EMA service is crucial for reducing the average travel times. In this paper we propose mechanisms that dynamically improve the allocation of ambulances to patients as well as the redeployment of available ambulances in the region under consideration. We test these mechanisms in different experiments using historical data from the EMA service of the Autonomous Region of Madrid in Spain: SUMMA112. The results empirically confirm that our proposal reduces the average response times of EMA services significantly.
Journal of the American College of Cardiology, Jun 1, 2014
The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administ... more The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events. Background Early IV metoprolol during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI). Methods The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 patients with Killip class II anterior STEMI presenting early after symptom onset (<6 h) and randomized them to pre-reperfusion IV metoprolol or control group. Long-term magnetic resonance imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimal 12-month clinical follow-up. Results Left ventricular ejection fraction (LVEF) at the 6 months MRI was higher after IV metoprolol (48.7 AE 9.9% vs. 45.0 AE 11.7% in control subjects; adjusted treatment effect 3.49%; 95% confidence interval [CI]: 0.44% to 6.55%; p ¼ 0.025). The occurrence of severely depressed LVEF (35%) at 6 months was significantly lower in patients treated with IV metoprolol (11% vs. 27%, p ¼ 0.006). The proportion of patients fulfilling Class I indications for an implantable cardioverter-defibrillator (ICD) was significantly lower in the IV metoprolol group (7% vs. 20%, p ¼ 0.012). At a median follow-up of 2 years, occurrence of the pre-specified composite of death, heart failure admission, reinfarction, and malignant arrhythmias was 10.8% in the IV metoprolol group versus 18.3% in the control group, adjusted hazard ratio (HR): 0.55; 95% CI: 0.26 to 1.04; p ¼ 0.065. Heart failure admission was significantly lower in the IV metoprolol group (HR: 0.32; 95% CI: 0.015 to 0.95; p ¼ 0.046). Conclusions In patients with anterior Killip class II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion. The METOCARD-CNIC Trial; NCT01311700) (
Circulation, Oct 1, 2013
Background-The effect of β-blockers on infarct size when used in conjunction with primary percuta... more Background-The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). Methods and Results-Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean±SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6±15.3 versus 32.0±22.2 g; adjusted difference, −6.52; 95% confidence interval, −11.39 to −1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was −8.13 (95% confidence interval, −13.10 to −3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). Conclusions-In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.
New England Journal of Medicine, 2014
BACKGROUND The direct-acting platelet P2Y 12 receptor antagonist ticagrelor can reduce the incide... more BACKGROUND The direct-acting platelet P2Y 12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown. METHODS We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days. RESULTS The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and inhospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used.
The new england journal o f medicine, 2014
BACKGROUND
The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the inciden... more BACKGROUND
The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether
prehospital administration of ticagrelor can improve coronary reperfusion and the
clinical outcome is unknown.
METHODS
We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours’ duration, comparing
prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory)
treatment with ticagrelor. The coprimary end points were the proportion of patients
who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have
Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at
initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.
RESULTS
The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two
coprimary end points did not differ significantly between the prehospital and inhospital groups. The absence of ST-segment elevation resolution of 70% or greater
after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients,
respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were
lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first
24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and
virtually identical in the two groups, regardless of the bleeding definition used.
CONCLUSIONS
Prehospital administration of ticagrelor in patients with acute STEMI appeared to
be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca;
ATLANTIC ClinicalTrials.gov number, NCT01347580.)
Optimización del uso de los Helicópteros Sanitarios en la Comunidad de Madrid, 2008
JACC. Cardiovascular interventions, Jan 4, 2016
The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre... more The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery study). The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). The ATLANTIC-H(24) analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction grade 3 flow, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Following PCI, largest between-group differen...
Knowledge-Based Systems, 2014
Defining inclusion and exclusion criteria, along with dose selection of the administered pharmaco... more Defining inclusion and exclusion criteria, along with dose selection of the administered pharmacological therapy, is critical in the early stages of a clinical trial design. The scientific method strongly recommends performing a profound bibliographic research in this regard, and for this purpose, we carefully reviewed previously conducted trials on the use of β-blockers in the setting of ST-segment–elevation acute myocardial infarction, taking note of the strengths and weaknesses of each of them. Thus, for the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) trial, we randomized anterior myocardial infarctions revascularized by primary angioplasty in <6 hours from symptom onset because this is the population that most benefits from any cardioprotective intervention. More important, and for safety reasons, we designed a trial to recruit patients with no obvious contraindications for the administration of intravenous metoprolol. Becaus...
Long-Term Benefit of Early Pre-Reperfusion Metoprolol Administration in Patients With Acute Myoca... more Long-Term Benefit of Early Pre-Reperfusion Metoprolol Administration in Patients With Acute Myocardial Infarction Results From the METOCARD-CNIC Trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) Gonzalo Pizarro, MD,*y Leticia Fernández-Friera, MD, PHD,*z Valentin Fuster, MD, PHD,*x Rodrigo Fernández-Jiménez, MD,*k José M. García-Ruiz, MD,*{ Ana García-Álvarez, MD, PHD,*# Alonso Mateos, MD,** María V. Barreiro, MD,yy Noemí Escalera, BPT,* Maite D. Rodriguez, RN,* Antonio de Miguel, MD,zz Inés García-Lunar, MD,*yxx Juan J. Parra-Fuertes, MD,kk Javier Sánchez-González, PHD,*{{ Luis Pardillos, MD,** Beatriz Nieto, MD,zzAdriana Jiménez, MD,## Raquel Abejón, RN,** Teresa Bastante, MD,*** Vicente Martínez de Vega, MD,y José A. Cabrera, MD, PHD,y Beatriz López-Melgar, MD,*kk Gabriela Guzman, MD, PHD,*yyy Jaime García-Prieto, BSC,* Jesús G. Mirelis, MD, PHD,*xx José Luis Zamorano, MD, PHD,k Agustín Albarrán, MD, PHD,kk Javier Goicolea, MD, PHD,xx Javier E...
OBJECTIVES The aim of this landmark exploratory analysis, ATLANTIC-H 24 , was to evaluate the eff... more OBJECTIVES The aim of this landmark exploratory analysis, ATLANTIC-H 24 , was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. BACKGROUND The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that
Knowledge-Based Systems, 2014
ABSTRACT The main objective of emergency medical assistance (EMA) services is to attend patients ... more ABSTRACT The main objective of emergency medical assistance (EMA) services is to attend patients with sudden diseases at any possible location within an area of influence. This usually consists in providing “in situ” assistance and, if necessary, the transport of the patient to a medical center. The potential of such systems to reduce mortality is directly related to the travel times of ambulances to emergency patients. An efficient coordination of the ambulance fleet of an EMA service is crucial for reducing the average travel times. In this paper we propose mechanisms that dynamically improve the allocation of ambulances to patients as well as the redeployment of available ambulances in the region under consideration. We test these mechanisms in different experiments using historical data from the EMA service of the Autonomous Region of Madrid in Spain: SUMMA112. The results empirically confirm that our proposal reduces the average response times of EMA services significantly.
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Papers by Vicente Sánchez-Brunete
The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether
prehospital administration of ticagrelor can improve coronary reperfusion and the
clinical outcome is unknown.
METHODS
We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours’ duration, comparing
prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory)
treatment with ticagrelor. The coprimary end points were the proportion of patients
who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have
Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at
initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.
RESULTS
The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two
coprimary end points did not differ significantly between the prehospital and inhospital groups. The absence of ST-segment elevation resolution of 70% or greater
after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients,
respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were
lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first
24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and
virtually identical in the two groups, regardless of the bleeding definition used.
CONCLUSIONS
Prehospital administration of ticagrelor in patients with acute STEMI appeared to
be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca;
ATLANTIC ClinicalTrials.gov number, NCT01347580.)
The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether
prehospital administration of ticagrelor can improve coronary reperfusion and the
clinical outcome is unknown.
METHODS
We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours’ duration, comparing
prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory)
treatment with ticagrelor. The coprimary end points were the proportion of patients
who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have
Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at
initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.
RESULTS
The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two
coprimary end points did not differ significantly between the prehospital and inhospital groups. The absence of ST-segment elevation resolution of 70% or greater
after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients,
respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were
lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first
24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and
virtually identical in the two groups, regardless of the bleeding definition used.
CONCLUSIONS
Prehospital administration of ticagrelor in patients with acute STEMI appeared to
be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca;
ATLANTIC ClinicalTrials.gov number, NCT01347580.)
Community-Acquired AKI: A Prospective Case-Control Study
Session Information
• AKI: Epidemiology, Risk Factors, and Prevention
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
• 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
• Ragnarsdóttir, Telma Huld, Internal Medicine Services, Landspitali - the National
University Hospital of Iceland, Reykjavik, Iceland
• Kristjansdottir, Margret, Internal Medicine Services, Landspitali - the National University
Hospital of Iceland, Reykjavik, Iceland
• Gislason, Gisli, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
• Sanchez-Brunete, Vicente, Department of Emergency Medicine, Landspitali–the National
University Hospital of Iceland, Reykjavik, Iceland
• Tomasdottir, Margret Olafia, Faculty of Medicine, University of Iceland, Reykjavik,
Iceland
• Samuelsson, Olafur Helgi, Department of Geriatric Medicine, Landspitali - the National
University Hospital of Iceland, Reykjavik, Iceland
• Palsson, Runolfur, Internal Medicine Services, Landspitali - the National University
Hospital of Iceland, Reykjavik, Iceland
• Indridason, Olafur S., Internal Medicine Services, Landspitali - the National University
Hospital of Iceland, Reykjavik, Iceland
Background
Acute kidney injury (AKI) represents an abrupt decline in kidney function occurring over hours
or days. While hospital-acquired AKI has been extensively studied, data on community-acquired
AKI are scarce. The aim of this study was to examine the incidence and causes of AKI among
patients presenting to the emergency department (ED).
Methods
This was a prospective case-control study in which serum creatinine (SCr) of all individuals
admitted to the ED of Landspitali–The National University Hospital were examined for the
presence of AKI. We present data from January 1 until March 3, 2020 and May 19 until
September 21, 2020. The study was paused between these periods due to the COVID-19
epidemic. All patients who met the KDIGO criteria for AKI were invited to participate.
Randomly selected control cases (1:2) were paired according to age, sex and time of ED
admission. Participants answered questions about their medical history and use of medications,
including over-the-counter (OTC) drugs. Medical records were reviewed with regard to medical
history. Logistic regression was used to identify factors associating with AKI.
Results
A total of 372 persons with AKI were identified, 315 (85%) of whom participated in the study.
The mean (±SD) age of AKI cases and controls was 66.6±16.1 years and 66.3±16.2 years,
respectively; 46% of cases and controls were female. AKI cases were significantly more likely
than controls to have used non-steroidal anti-inflammatory drugs (NSAIDs) (31.1% vs 22.2%,
p=0,003) in the week preceding the ED visit, particularly OTC NSAIDs (24.7% vs 16.2%,
p=0.001). In the logistic regression analysis, AKI was associated with vomiting (OR 2.40 95%CI
1.74-3.35), diarrhea (OR 1.35, 95%CI 1.00-1.84), diabetes (OR 1.66, 95%CI 1,17-2,35) and
NSAID use (OR 1.60, 95%CI 1.18-2.23), but a statistically significant relationship was not
observed for use of ACE inhibitors/angiotensin receptor blockers or diuretics, or a history of
hypertension, vascular disease or chronic kidney disease.
Conclusion
These results suggest that volume depletion and the use of NSAIDs play a major role in the
development of AKI in the community setting. Frequent use of OTC NSAIDs is a concern and
should be addressed in light of serious adverse effects.