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Predictive value of CHA2DS2VASC score for contrast-induced nephropathy after primary percutaneous coronary
Ahmad Samir1, Wafik Gabra2, Hossam Alhossary3
1Cardiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Ahmadsamir11@cu.edu.eg.
Insights
The CHA2DS2-VASc score effectively predicts contrast-induced nephropathy (CIN) risk in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). This score is a practical alternative to Mehran's score for identifying patients at high risk for CIN.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) face a higher risk of contrast-induced nephropathy (CIN) compared to elective PCI.
- The Mehran's score, commonly used to predict CIN, is complex and difficult to memorize.
- This study investigated the predictive value of the CHA2DS2-VASc score for CIN in STEMI patients prior to pPCI.
Purpose of the Study:
- To evaluate the CHA2DS2-VASc score's utility in predicting CIN in STEMI patients undergoing pPCI.
- To compare the predictive accuracy of the CHA2DS2-VASc score with the Mehran's score for CIN.
- To identify a practical and easily memorizable tool for assessing CIN risk in this patient population.
Main Methods:
- A cohort of 500 acute STEMI patients undergoing pPCI was studied.
- Data collected included CHA2DS2-VASc score, Mehran's score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV), and CMV/eGFR ratio.
- CIN was defined as a 0.5 mg/dL absolute or 25% relative increase in serum creatinine post-pPCI. Predictive accuracy was assessed using ROC curve analysis.
Main Results:
- Contrast-induced nephropathy (CIN) occurred in 7% of the study cohort.
- Patients who developed CIN had significantly higher CHA2DS2-VASc scores, Mehran's scores, and CMV/eGFR ratios.
- The CHA2DS2-VASc score (≥4) and Mehran's score were independent predictors of CIN, with comparable predictive abilities.
- CMV/eGFR ratio also emerged as an independent predictor for CIN.
Conclusions:
- The CHA2DS2-VASc score is a practical, easily memorizable, and effective tool for predicting CIN risk in STEMI patients before pPCI.
- Routine calculation of the CHA2DS2-VASc score can aid in guiding preventive and therapeutic interventions for CIN.
- This score offers a valuable alternative to the Mehran's score for risk stratification in this high-risk group.
Background:
ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) are at increased risk for contrast-induced nephropathy (CIN) than elective PCI procedures. Routine calculation of Mehran's score is limited by its complexity and difficulty to memorize. This study evaluated CHA2DS2-VASc score predictive utility for CIN in STEMI patients before pPCI.
Results:
Consecutive 500 acute STEMI patients presenting to two Egyptian pPCI centers were recruited. Exclusion criteria included cardiogenic shock or known severe renal impairment (baseline serum creatinine ≥ 3 mg/dL) or current or previous indication of hemodialysis. CHA2DS2VASC score, Mehran's score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV) and CMV/eGFR ratio were collected for all patients. Post-pPCI CIN (defined as 0.5 mg/dL absolute increase or 25% relative increase of serum creatinine from baseline) and predictive accuracy of CHA2DS2VASC and Mehran's scores were evaluated. CIN occurred in 35 (7%) of the study group. Values of CHA2DS2VASC score, Mehran's score, baseline eGFR, CMV and CMV/eGFR ratio were significantly higher in those who developed CIN compared to those who did not. CHA2DS2VASC score, Mehran's score and CMV/eGFR were found to be independent predictors for CIN (P < 0.001 for all). ROC curve analysis revealed that CHA2DS2VASC ≥ 4 had a superb predictive ability, comparable to Mehran's score, for post-pPCI CIN.
Conclusions:
Being practical, easily memorizable and applicable before proceeding to pPCI, routine CHA2DS2VASC score calculation in STEMI patients can effectively predict CIN risk and guide preventive and/or therapeutic interventions.
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