Abstract 15116: A Simplified Risk Score for the Prediction of Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Interventions After Acute Myocardial Infarction
Introduction: Contrast-induced nephropathy (CIN) following percutaneous coronary interventions (PCI) in patients with acute myocardial infarction (AMI) is associated with high morbidity and mortality.
Hypothesis: In this prospective study we assessed the predictive value of a model incorporating established clinical risk factors and evaluated its diagnostic performance in comparison to a widely used risk prediction score for CIN.
Methods: Consecutive patients (348 AMI subjects) undergoing PCI were recruited. Creatinine levels were detected on admission and 24, 48, and 72 hours after PCI, and CIN was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Several demographic, clinical and laboratory characteristics were also recorded. The Mehran score was used as an established score for the prediction of CIN after PCI.
Results: CIN developed in 54 (15.5%) of the patients. Patients with CIN were older (p<0.001) and had higher CRP (p=0.007) and creatinine levels (p=0.005) at admission, whereas their ejection fraction (EF) (p<0.001) and hemoglobin (p=0.001) were lower. In multivariate analysis after incorporating potential confounders, CRP at admission was an independent predictor of CIN (OR for logCRP: 2.00, 95%CI: 1.17-3.43, p=0.01). In ROC curve analysis, a model incorporating CRP, age, glomerular filtration rate (GFR), and EF, showed good accuracy in predicting the development of CIN (c-statistic: 0.84) and outperformed the established Mehran score (c-statistic: 0.768) (p=0.03). A total risk score (range 0-11) derived from the proposed model yielded 96.9% specificity, 60% positive predictive value, and 87.7% negative predictive value, and classified 85.9% of our patients correctly for CIN. The very low-risk group was defined as a total of the weighted risk score of 0 to 1, the low-risk from 2 to 5, the moderate from 6 to 9 and the high risk 10 and 11. Our classification indicates a range of probabilities for CIN from 1.06% and 5.76% for patients in the very low and low risk category to 32.6% and 69.4% for individuals in the moderate and high risk category.
Conclusion: A model incorporating age and admission CRP, EF and GFR emerged as an accurate tool for predicting CIN in this context, outperforming other established risk scores.
Author Disclosures: G. Lazaros: None. T. Zografos: None. E. Oikonomou: None. G. Siasos: None. G. Georgiopoulos: None. E. Vavouranakis: None. A. Antonopoulos: None. K. Kalogeras: None. S. Tsalamandris: None. G. Vogiatzi: None. D. Tousoulis: None.
- © 2016 by American Heart Association, Inc.