The predictive value of residual SYNTAX score and SYNTAX revascularization index for contrast-induced nephropathy in
1Giresun University Faculty of Medicine, Department of Cardiology, Giresun, Turkey. sncrcmc@gmail.com.
Insights
Incomplete revascularization score (rSS) and treated coronary artery disease burden (SRI) predict contrast-induced nephropathy (CIN) in ST-segment elevation myocardial infarction (STEMI) patients. The residual SYNTAX score (rSS) demonstrated superior diagnostic power for predicting CIN.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients.
- Assessing the burden of treated coronary artery disease and the degree of revascularization is crucial for predicting adverse outcomes.
- The residual SYNTAX score (rSS) and SYNTAX revascularization index (SRI) are proposed metrics to quantify these aspects.
Purpose of the Study:
- To evaluate the association between incomplete revascularization score (rSS) and treated coronary artery disease burden (SRI) with the development of CIN.
- To determine the predictive value of rSS and SRI for CIN in STEMI patients undergoing primary PCI.
Main Methods:
- A cohort of 604 STEMI patients who underwent primary PCI between January 2018 and December 2021 were analyzed.
- Patients were categorized into CIN (+) and CIN (-) groups based on CIN development.
- SYNTAX score I and II, rSS, and SRI were calculated, and their diagnostic power for CIN prediction was assessed using logistic regression analysis.
Main Results:
- CIN was observed in 17.8% of patients.
- Higher SYNTAX scores and rSS, and lower SRI were observed in the CIN (+) group compared to the CIN (-) group (p < 0.001 for rSS and SRI).
- rSS showed significant diagnostic power for predicting CIN (AUC = 0.752, p < 0.001), with a cut-off value of 5.2, 81% sensitivity, and 69% specificity.
Conclusions:
- Both rSS and SRI are associated with CIN development in STEMI patients.
- rSS demonstrates superior predictive capability for CIN compared to SRI.
- rSS and SRI are identified as independent predictors for CIN development following primary PCI in STEMI.
Objective:
We aimed to evaluate the association of incomplete revascularization score and the treated coronary artery disease burden with the development of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention. Incomplete revascularization score was expressed by the residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) (rSS) and the treated coronary artery disease burden was expressed by the SYNTAX revascularization index (SRI).
Patients And Methods:
In our study, 604 sequential patients who underwent percutaneous coronary intervention diagnosed with STEMI between January 2018 and December 2021 were included. Patients were categorized into two groups; 'CIN (+)' who developed CIN and 'CIN (-)' who did not develop CIN. Baseline demographic, laboratory, echocardiographic, and angiographic data of the groups were compared. SYNTAX score I and II, rSS, and SRI were calculated. The diagnostic power of these angiographic parameters in the prediction of CIN was evaluated. Predictors for the development of CIN in STEMI patients were investigated.
Results:
The mean age of the patients included in our study was 58.7 ± 12.4 years, and 79.9% of them were men. CIN was observed in 17.8% of study patients. The SYNTAX score [17.8 (11.4-24.2) vs. 15.1 (10.1-21.2); p = 0.008] and rSS [8.14 (3.9-116) vs. 4.2 (2.6-8.2); p < 0.001] were higher and SRI [56.2 ± 10.2 vs. 71.1 ± 13.6; p < 0.001] was lower in the CIN (+) group compared to the CIN (-) group. In predicting CIN, rSS was found to have significant diagnostic power at a cut-off value of 5.2, sensitivity of 81% and specificity of 69% [AUC (95% CI) = 0.752 (0.602-0.814); p < 0.001]. In logistic regression analysis, rSS [OR (95% CI) = 1.492 (1.124-1.884); p < 0.001] and SRI [OR (95% CI) = 1.055 (1.027-1.092); p < 0.001] were defined as independent predictors for the development of CIN.
Conclusions:
rSS and SRI are associated with CIN in STEMI patients. Although rSS is superior in predicting CIN, both angiographic scorings have significant diagnostic power. rSS and SRI are independent predictors for the development of CIN.
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