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A New and Simple Risk Predictor of Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary
Ahmet Kaya1, Ahmet Karataş2, Yasemin Kaya3
1Department of Cardiology, Ordu University Medical School, Ordu, Turkey.
Insights
The Thrombolysis in Myocardial Infarction risk index (TRI) can predict contrast-induced nephropathy (CIN) in ST-elevation myocardial infarction (STEMI) patients. This simple index offers a reliable risk assessment without requiring laboratory tests.
Area of Science:
- Cardiology
- Nephrology
- Medical Prognostics
Background:
- The Thrombolysis in Myocardial Infarction (TRI) risk index estimates prognosis in coronary artery disease patients without lab parameters.
- Contrast-induced nephropathy (CIN) is a concern in patients undergoing procedures with contrast dye.
Purpose of the Study:
- To investigate the relationship between baseline TRI and CIN in ST-elevation myocardial infarction (STEMI) patients.
- To evaluate TRI as a predictive tool for CIN in STEMI.
Main Methods:
- A cohort of 963 STEMI patients undergoing primary percutaneous intervention was analyzed.
- TRI was calculated on admission using heart rate, age, and systolic blood pressure.
- CIN was defined as a ≥25% increase in serum creatinine 48 hours post-procedure.
Main Results:
- CIN occurred in 13% of patients.
- Patients who developed CIN had a significantly higher baseline TRI (32.9 vs 19.9).
- TRI and contrast media amount were independent predictors of CIN, with a TRI threshold of ≥25.8 showing 67.1% sensitivity and 80.4% specificity.
Conclusions:
- The TRI is an independent predictor of CIN in STEMI patients.
- TRI serves as a simple, reliable tool for assessing CIN risk without laboratory parameters.
Background:
The thrombolysis in myocardial infarction risk index (TRI) was developed to estimate prognosis at the initial contact of the healthcare provider in coronary artery disease patients without laboratory parameters. In this study, we aimed to investigate the relationship of the baseline TRI and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI).
Methods:
A total of 963 consecutive STEMI diagnosed patients who underwent primary percutaneous intervention were included in the study. TRI was calculated using the formula "heart rate × (age/10) 2/SBP" on admission. CIN was defined as an increase in serum creatinine concentration ≥25%, 48 hours later over the baseline.
Results:
Of the total of 963 patients, CIN was observed in 13% (n=128). TRI was significantly higher in the CIN (+) group compared with the CIN (-) group (32.9 ± 18.8 vs 19.9 ± 9.9, P < 0.001). There was a stronger correlation between CIN and age, diastolic blood pressure, heart rate, Killip class, left ventricular ejection fraction, amount of contrast media, and diabetes mellitus. The amount of contrast media (OR 1.010, 95% CI 1.007-1.012, P < 0.001) and TRI (OR 1.047, 95% CI 1.020-1.075, P=001) were independent predictors of CIN. The best threshold TRI for predicting CIN was ≥25.8, with a 67.1% sensitivity and 80.4% specificity (area under the curve (AUC): 0.740, 95% CI: 0.711-0.768, P < 0.001).
Conclusion:
TRI is an independent predictor of CIN, and it may be used as a simple and reliable risk assessment of CIN in STEMI patients without the need for laboratory parameters.
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