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Zwolle risk score predicts contrast-induced acute kidney injury in STEMI patients undergoing PCI

Zwolle-Risikoscore als Prädiktor der kontrastmittelinduzierten akuten Niereninsuffizienz bei STEMI-Patienten nach PCI

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Abstract

Objective

Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Mehran risk score was defined originally in elective PCI and may be predictive of CI-AKI. The aim of the present study was to investigate whether the Zwolle score predicts CI-AKI in patients with acute STEMI undergoing primary PCI.

Patients and methods

We analyzed the data of 314 consecutive patients (mean age 56.3 ± 11.4 years) with acute STEMI undergoing primary PCI. The study population was divided into two groups according to CI-AKI development. The Mehran score, Zwolle score, baseline characteristics, and in-hospital outcomes were recorded.

Results

Patients with CI-AKI had higher Mehran and Zwolle scores. In a receiver operating characteristic (ROC) curve analysis, high area under the curve (AUC) values were determined for Zwolle and Mehran scores (0.85 and 0.79, respectively) for CI-AKI development. A Zwolle score greater than  2 predicted CI-AKI with a sensitivity of 76.3 % and a specificity of 75.4 %. A Mehran score greater than 5 predicted CI-AKI with a sensitivity of 71.1 % and a specificity of 73.6 %.

Conclusion

Zwolle score predicts CI-AKI slightly better than the Mehran score in patients with STEMI undergoing primary PCI. This simple score can be used at the catheterization laboratory for risk stratification for the development of CI-AKI.

Zusammenfassung

Ziel

Die kontrastmittelinduzierte akute Niereninsuffizienz (CI-AKI) ist eine häufige Komplikation bei Patienten mit akutem ST-Hebungs-Infarkt (STEMI), bei denen eine primäre perkutane Koronarintervention (PCI) erfolgt. Der Mehran-Risikoscore war ursprünglich für die elektive PCI definiert und kann eine CI-AKI vorhersagen. Ziel der vorliegenden Studie war es zu untersuchen, ob sich mit dem Zwolle-Score eine CI-AKI bei Patienten mit akutem STEMI und primärer PCI vorhersagen lässt.

Patienten und Methoden

Die Daten von 314 konsekutiven Patienten (Durchschnittsalter: 56,3 ± 11,4 Jahre) mit akutem STEMI und Durchführung einer primären PCI wurden ausgewertet. Die Studienpopulation wurde je nach Auftreten einer CI-AKI oder nicht in 2 Gruppen aufgeteilt. Der Mehran-Score, der Zwolle-Score, Merkmale zu Studienbeginn und Ergebnisse während der stationären Behandlung wurden dokumentiert.

Ergebnisse

Patienten mit CI-AKI wiesen einen höheren Mehran- und Zwolle-Score auf. Bei der Receiver-operating-Characteristic(ROC)-Kurven-Analyse wurden hohe Werte für die Fläche unter der Kurve (AUC) im Zwolle- und Mehran-Score (0,85 bzw. 0,79) in Bezug auf die Entwicklung einer CI-AKI festgestellt. Ein Zwolle-Score > 2 war mit einer Sensitivität von 76,3 % und einer Spezifität von 75,4 % ein Prädiktor für eine CI-AKI. Ein Mehran-Score > 5 sagte eine CI-AKI mit einer Sensitivität von 71,1 % und einer Spezifität von 73,6 % voraus.

Schlussfolgerung

Mit dem Zwolle-Score lässt sich bei Patienten mit STEMI, bei denen eine primäre PCI erfolgt, eine CI-AKI etwas besser als mit dem Mehran-Score voraussagen. Dieser einfache Risikoscore kann zur Risikostratifizierung für das Auftreten einer CI-AKI im Katheterlabor eingesetzt werden.

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Compliance with ethical guidelines

Conflict of interest. S. Kul, H. Uyarel, O.T. Kucukdagli, M. Turfan, M.A. Vatankulu, A. Tasal, E. Erdogan, E. Asoglu, M. Sahin, T.S. Guvenc, and O. Goktekin state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Faculty of Medicine, Cardiology Department, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan cad.), 34093, Istanbul, Turkey

    S. Kul MD, H. Uyarel, M. Turfan, M.A. Vatankulu, A. Tasal, E. Erdogan, E. Asoglu & O. Goktekin

  2. Faculty of Medicine, Emergency Department, Bezmialem Vakif University, Istanbul, Turkey

    O.T. Kucukdagli

  3. Faculty of Medicine, Cardiology Department, Yuzuncu Yil University, Van, Turkey

    M. Sahin

  4. Faculty of Medicine, Cardiology Department, Kafkas University, Kars, Turkey

    T.S. Guvenc

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  1. S. Kul MD
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  2. H. Uyarel
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Correspondence to S. Kul MD.

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Kul, S., Uyarel, H., Kucukdagli, O. et al. Zwolle risk score predicts contrast-induced acute kidney injury in STEMI patients undergoing PCI. Herz 40, 109–115 (2015). https://doi.org/10.1007/s00059-013-3957-1

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  • DOI: https://doi.org/10.1007/s00059-013-3957-1

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