Coronary Artery Disease
Comparison of Different Risk Scores for Predicting Contrast Induced Nephropathy and Outcomes After Primary Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2016.03.033Get rights and content

Accurate risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We aimed to compare the prognostic value of validated risk scores for CIN. We prospectively enrolled 422 consecutive patients with STEMI undergoing PPCI. Mehran; Gao; Chen; age, serum creatinine (SCr), or glomerular filtration rate, and ejection fraction (ACEF or AGEF); and Global Registry for Acute Coronary Events risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer–Lemeshow test for calibration. CIN was defined as either CIN-narrow (increase in SCr ≥0.5 mg/dl) or CIN broad (≥0.5 mg/dl and/or a ≥25% increase in baseline SCr). All risk scores had relatively high predictive values for CIN-narrow (c-statistic: 0.746 to 0.873) and performed well for prediction of in-hospital death (0.784 to 0.936), MACEs (0.685 to 0.763), and 3-year all-cause mortality (0.655 to 0.871). The ACEF and AGEF risk scores had better discrimination and calibration for CIN-narrow and in-hospital outcomes. However, all risk score exhibited low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). In conclusion, risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in patients with STEMI undergoing PPCI. The ACEF and AGEF risk scores appear to have greater prognostic value.

Section snippets

Methods

This study prospectively enrolled a series of consecutive patients with STEMI who underwent PPCI at Guangdong General Hospital, from March 2010 to October 2012. Acute STEMI was defined as the presence of typical chest pain and accompanying symptoms for ≥30 minutes but <12 hours in the presence of ST-segment elevation ≥1 mm in at least 2 continuous leads or a new or undetermined duration of left branch bundle block with ≥2 times increase in cardiac enzymes (troponin I or T).10 Patients were

Results

A total of 422 consecutive patients (age: 62.48 ± 12.45 years) with STEMI were included in the present study. Baseline characteristics, medications, procedural variables, and the mean of all risk scores are presented in Table 2. Of the entire cohort, 15.2% patients were women, 49.3% had hypertension, 22% had diabetes mellitus, and 35.1% had anemia. Complete follow-up was achieved in 91.6% of patients (35 patients were lost to follow-up). The overall incidence of CIN was 7.3% for CIN-narrow and

Discussions

The present study demonstrated that the risk scores tested had high discriminatory ability with the majority also having good calibration for CIN-narrow, in-hospital death and MACEs, and 3-year all-cause mortality, in patients with STEMI receiving PPCI. The ACEF and AGEF risk scores had slightly better prognostic values than other risk scores. However, when predicting CIN-broad and 3-year MACEs, all scores showed poor discriminatory ability.

Identification and intervention for patients with

Disclosures

The authors have no conflicts of interest to disclose.

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