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CHADS2 score predicts risk of contrast-induced nephropathy in stable coronary artery disease patients undergoing
Ruey-Hsing Chou1, Po-Hsun Huang2, Chien-Yi Hsu3
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Insights
The CHADS2 score effectively predicts contrast-induced nephropathy (CIN) risk in patients undergoing percutaneous coronary intervention (PCI). Higher scores correlate with increased CIN and major adverse cardiovascular events (MACEs), proving useful in clinical settings.
Area of Science:
- Cardiology
- Nephrology
- Medical Informatics
Background:
- Contrast-induced nephropathy (CIN) is a significant risk following percutaneous coronary intervention (PCI).
- Existing risk stratification tools for CIN may require enhancement for improved accuracy.
- The CHADS2 score, commonly used for stroke risk, is explored for its utility in predicting CIN.
Purpose of the Study:
- To evaluate the correlation between the CHADS2 score and the risk of developing CIN after elective PCI.
- To compare the predictive accuracy of the CHADS2 score against other established risk scoring systems (R2CHADS2 and Mehran's risk score) for CIN.
Main Methods:
- A retrospective study of 539 patients undergoing elective PCI.
- Calculation of CHADS2, R2CHADS2, and Mehran's risk scores based on patient comorbidities.
- Definition of CIN as a serum creatinine increase >0.5 mg/dL or >25% within 48 hours post-PCI.
- Follow-up for CIN and major adverse cardiovascular events (MACEs).
Main Results:
- The incidence of CIN was 10.2% and MACEs was 16.7% over a mean follow-up of 1.57 years.
- Each 1-point increase in the CHADS2 score was independently associated with a 37% increased risk of CIN (OR, 1.37) and a 49% increased risk of MACEs (HR, 1.49).
- The CHADS2 score demonstrated non-inferior discriminatory performance compared to R2CHADS2 and Mehran's risk score for predicting CIN.
Conclusions:
- The CHADS2 score serves as a simple and effective predictor for CIN in patients undergoing elective PCI.
- Utilizing the CHADS2 score can aid in identifying patients at higher risk for CIN, facilitating preventative strategies.
Background/Purpose:
To investigate the correlation between the CHADS2 score and risk of contrast-induced nephropathy (CIN), we conducted a retrospective study in patients who underwent elective percutaneous coronary intervention (PCI) and compared its accuracy with previous scoring systems.
Methods:
A total of 539 patients who underwent elective PCI were enrolled. Based on their underlying diseases, such as hypertension, diabetes, and kidney disease, CHADS2 score, R2CHADS2 score, and Mehran's risk score were calculated for each patient. Incidence of CIN was defined as a rise in serum creatinine >0.5 mg/dL or >25% increase in baseline within 48 hours after PCI. All study participants were followed up until October 2014, or until the occurrence of major adverse cardiovascular events (MACEs).
Results:
Overall, 55 cases (10.2%) of CIN and 90 cases (16.7%) of MACEs were identified after participants were followed up for 1.57 ± 1.46 years. The study cohort was divided into three groups according to CHADS2 scores: score 0, score 1-2, and score 3-6. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 37% increase in the risk of CIN (odds ratio, 1.37; 95% confidence interval, 1.00-1.87; p = 0.048) and a 49% increase in MACEs (hazard ratio, 1.49; 95% confidence interval, 1.18-1.88, p = 0.001). In pairwise comparison, the discriminatory performance of CHADS2 score was not inferior to either R2CHADS2 score (p = 0.226) or Mehran's risk score (p = 0.075).
Conclusion:
CHADS2 score could be a simple and useful predictor for CIN in patients undergoing elective PCI.
