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Background Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study. Methods and results Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72–0.78; vs. Mehran c-index 0.69, 95% CI 0.66–0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12–0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79–0.91; vs. Mehran c-index 0.75, 95% CI 0.66–0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk. Conclusion In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the GRACE model while showing less accurate calibration. Results for the outcome ‘need for dialysis’ were equivocal. Graphic abstract

Background Risk prediction with the GRACE risk model is guideline-recommended clinical practice in acute coronary syndrome (ACS). However, more modern risk models such as ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With the Guidelines) and National Cardiovascular Data Registry (NCDR) risk models are available. We aimed to compare these models to the established GRACE risk model in ACS. Methods and results In-hospital mortality was retrospectively assessed in 1,138 patients undergoing cardiac catheterization for Non-ST-Elevation Myocardial Infarction (NSTEMI, 566 patients, 70.7% male) or ST-Elevation Myocardial Infarction (STEMI, 572 patients, 69.1% male) at a German University Hospital from 2014 to 2017. In-hospital mortality was 14.7% for STEMI and 3.7% for NSTEMI, respectively. GRACE, ACTION and NCDR risk models for prediction of in-hospital mortality were calculated for individual patients, 0.75% missing data were imputed. ACTION risk model showed a good discrimination of risk (c-index 0.85, 95% confidence interval (CI) 0.83–0.87) with a slight numerical advantage in NSTEMI (c-index 0.92, 95% CI 0.86–0.98) over STEMI patients (c-index 0.83, 95% CI 0.79–0.88). The NCDR risk model showed comparable performance in the overall cohort (c-index 0.86, 95% CI 0.84–0.88; NCDR vs. ACTION p=0.4097), also with superior performance in NSTEMI (c-index 0.89, 95% CI 0.86–0.91) vs. STEMI (c-index 0.81, 95% CI 0.78–0.84). The GRACE risk model showed significantly worse performance in the overall cohort (c-index 0.76, 95% CI 0.74–0.79; vs ACTION p&lt;0.0001; vs. NCDR p&lt;0.0001) and in STEMI patients (c-index 0.72, 95% CI 0.69–0.76; vs ACTION p&lt;0.0001; vs. NCDR p=0.0018). In NSTEMI patients, GRACE discrimination performance was comparable to NCDR (c-index 0.87, 95% CI 0.84–0.90, p=0.73), but still inferior to ACTION (p=0.04). The ACTION risk model showed a good calibration whereas NCDR and GRACE models lacked accuracy in our cohort. Conclusion In a contemporary German patient population with acute coronary syndrome, ACTION and NCDR risk models outperform the established GRACE risk model for prediction of in-hospital mortality. This performance difference was more pronounced in STEMI than in NSTEMI. Funding Acknowledgement Type of funding source: None