The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2023
Predictive value of CHA2DS2VASC score for contrast-induced nephropathy after primary percutaneous coronary intervention for patients presenting with acute ST-segment elevation myocardial infarction.
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Samir Ahmad, Gabra Wafik, Alhossary Hossam, Bakhoum Sameh
Аннотация
BACKGROUND: ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) are at increased risk for contrast-induced nephropathy (CIN) than elective PCI procedures. Routine calculation of Mehran's score is limited by its complexity and difficulty to memorize. This study evaluated CHA2DS2-VASc score predictive utility for CIN in STEMI patients before pPCI.
RESULTS: Consecutive 500 acute STEMI patients presenting to two Egyptian pPCI centers were recruited. Exclusion criteria included cardiogenic shock or known severe renal impairment (baseline serum creatinine ≥ 3 mg/dL) or current or previous indication of hemodialysis. CHA2DS2VASC score, Mehran's score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV) and CMV/eGFR ratio were collected for all patients. Post-pPCI CIN (defined as 0.5 mg/dL absolute increase or 25% relative increase of serum creatinine from baseline) and predictive accuracy of CHA2DS2VASC and Mehran's scores were evaluated. CIN occurred in 35 (7%) of the study group. Values of CHA2DS2VASC score, Mehran's score, baseline eGFR, CMV and CMV/eGFR ratio were significantly higher in those who developed CIN compared to those who did not. CHA2DS2VASC score, Mehran's score and CMV/eGFR were found to be independent predictors for CIN (P < 0.001 for all). ROC curve analysis revealed that CHA2DS2VASC ≥ 4 had a superb predictive ability, comparable to Mehran's score, for post-pPCI CIN.
CONCLUSIONS: Being practical, easily memorizable and applicable before proceeding to pPCI, routine CHA2DS2VASC score calculation in STEMI patients can effectively predict CIN risk and guide preventive and/or therapeutic interventions.
RESULTS: Consecutive 500 acute STEMI patients presenting to two Egyptian pPCI centers were recruited. Exclusion criteria included cardiogenic shock or known severe renal impairment (baseline serum creatinine ≥ 3 mg/dL) or current or previous indication of hemodialysis. CHA2DS2VASC score, Mehran's score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV) and CMV/eGFR ratio were collected for all patients. Post-pPCI CIN (defined as 0.5 mg/dL absolute increase or 25% relative increase of serum creatinine from baseline) and predictive accuracy of CHA2DS2VASC and Mehran's scores were evaluated. CIN occurred in 35 (7%) of the study group. Values of CHA2DS2VASC score, Mehran's score, baseline eGFR, CMV and CMV/eGFR ratio were significantly higher in those who developed CIN compared to those who did not. CHA2DS2VASC score, Mehran's score and CMV/eGFR were found to be independent predictors for CIN (P < 0.001 for all). ROC curve analysis revealed that CHA2DS2VASC ≥ 4 had a superb predictive ability, comparable to Mehran's score, for post-pPCI CIN.
CONCLUSIONS: Being practical, easily memorizable and applicable before proceeding to pPCI, routine CHA2DS2VASC score calculation in STEMI patients can effectively predict CIN risk and guide preventive and/or therapeutic interventions.