Mehran Contrast-Induced Nephropathy Risk Score Predicts Short- and Long-Term Clinical Outcomes in Patients With ST-Elevation–Myocardial Infarction

Sgura, Fabio; Bertelli, Luca; Monopoli, Daniel; Leuzzi, Chiara; Guerri, E; Sparta, I; Politi, Luigi; Aprile, Alessandro; Amato, A.; Rossi, Rosario; Biondi‐Zoccai, Giuseppe; Sangiorgi, Giuseppe; Modena, Maria Grazia

doi:10.1161/circinterventions.110.955310

Cited by 135 publications

(102 citation statements)

References 39 publications

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“…The reported incidence of AKI is 1% to 3% in patients undergoing elective PCI17, 19, 20, 21 but rises significantly to 10% to 16% in patients undergoing pPCI 3, 22, 23. The large increase in incident AKI is the result of heart failure, hemodynamic instability, and pharmacological interventions associated with STEMI rather than the use of greater contrast volume.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Caspi

Habib

Cohen

et al. 2017

JAHA

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BackgroundAcute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI) is frequently interpreted as contrast‐induced AKI but may result from other insults. We aimed to determine the causal association of contrast material exposure and the incidence of AKI following pPCI using a control group of propensity score–matched patients with ST‐segment–elevation myocardial infarction who were not exposed to contrast material.Methods and ResultsWe studied 2025 patients with ST‐segment–elevation myocardial infarction who underwent pPCI and 1025 patients receiving fibrinolysis or no reperfusion who were not exposed to contrast material during the first 72 hours of hospital stay (control group). AKI was defined as creatinine of ≥0.5 mg/dL or >25% rise within 72 hours. AKI rates were similar in the pPCI and control groups (10.3% versus 12.1%, respectively; P=0.38). Propensity score matching resulted in 931 matched pairs with PCI and no PCI, with balanced baseline covariates (standardized difference <0.1). Among propensity score–matched patients, AKI rates were not significantly different with and without PCI (8.6% versus 10.9%, P=0.12). In the pPCI cohort, independent predictors of AKI included age ≥70 years, insulin‐treated diabetes mellitus, diuretic therapy, anterior infarction, baseline estimated glomerular filtration rate, and variables related to the presence of pump failure (higher Killip class, intra‐aortic balloon pump use) and reduced left ventricular ejection fraction but not contrast material dose. A risk score based on the PCI cohort had similar discriminatory capacity for AKI in the control group (C statistic 0.81±0.02 and 0.78±0.02, respectively; P=0.26).ConclusionsThe development of AKI in patients with ST‐segment–elevation myocardial infarction undergoing pPCI is mainly related to older age, baseline estimated glomerular filtration rate, heart failure, and hemodynamic instability. Risk for AKI is similar among ST‐segment–elevation myocardial infarction patients with and without contrast material exposure.

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Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Caspi

Habib

Cohen

et al. 2017

JAHA

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“…This score, when proposed, was observed to have a c-statistic of 0.67 but excluded patients treated with PPCI and patients in shock [8] However, the Mehran risk score was later tested for patients with STEMI who underwent primary PCI and showed a strong predictive value for CIN (c-statistic: 0.80 to 0.84) [9]. Ando et al, demonstrated that the ACEF risk score which include Age, serum crat is useful to predict CIN in patients with STEMI, while also demonstrating that the modified ACEF (AGEF) score has a similar discriminative ability for CIN [10,11].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Predictive Value for Different Risk Scores for Predicting Contrast Induced Nephropathy and Short Outcome after Primary Percutaneous Coronary Intervention

Mokarrab¹,

Ismail²,

Mostafa³

et al. 2017

J Clin Exp Cardiolog

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Background: Meticulous risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PPCI). Aim of the work:To compare between different risk scores for predicting contrast-induced nephropathy (CIN) and short outcome after primary percutaneous coronary intervention in patients with ST segment elevation myocardial infarction. Materials and methods:We prospectively enrolled 100 patients who presented with STEMI and treated with Primary PCI. Mehran, Gao, Chen, ACEF or AGEF (age, serum creatinine, or glomerular filtration rate, and ejection fraction); and GRACE (Global Registry for Acute Coronary Events) risk scores were calculated for each patient. The predictive accuracy of the 6 scores for CIN, in-hospital death and major adverse clinical events (MACEs) were assessed by Receiver operating characteristics (ROC) curve. CIN was defined as an absolute increase of serum creatinine by ≥ 0.5 mg/dl or a relative increase of serum creatinine by ≥ 25% from baseline value, at 48-72 h following the exposure to contrast media (CM). The data was analyzed using Chi-square test using SPSS (Statistical package for social science) software.Results: All risk scores had relatively good predictive accuracy for CIN (Area under the curve (AUC) ranged from 0.671 to 0.829) and performed well for prediction of in-hospital death (AUC ranged from 0.838 to 0.973) and MACEs (AUC ranged from 0.815 to 0.926). The Mehran and Gao risk scores had better predictive accuracy for CIN. While Mehran and GRACE risk scores had better predictive accuracy for in-hospital death and MACEs. Conclusion:Risk scores for predicting CIN perform well in stratifying the risk of CIN, in-hospital death and MACEs in patients with STEMI undergoing PPCI. The Gao, Mehran risk scores appear to have greater predictive value for CIN. While GRACE and Mehran scores had highest predictive accuracy for in hospital death and MACEs than the other risk scores.

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“…10 However, this is not the case for patients with known reduced renal function or renal risk factors where a permanent reduction in renal function and a poorer prognosis may be the consequence. 11 To avoid these serious side effects of contrast administration, 2 precautions in general are recommended, namely to reduce the dose of contrast media as much as possible 3 and to ensure optimal hydration before and immediately after the procedure by administration of intravenous sodium chloride. 12 In addition to these general recommendations, several more specific pharmacological interventions have been proposed for the protection of renal function.…”

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confidence: 99%

“…15,16 Patients treated for STEMI with primary PCI are most often exposed for contrast media without preexisting knowledge of renal function, and the patients are in different conditions of hydration. Only a few studies 7,11,17 have investigated this problem in different settings. To investigate the degree of renal impairment and the possible preventive effect of NAC and intravenous NaHCO 3 , alone or in combination, we initiated the present randomized and prospective study.…”

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confidence: 99%

Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment–Myocardial Infarction

Thayssen

Lassen

Jensen

et al. 2014

Circ: Cardiovascular Interventions

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Background-Contrast-induced nephropathy (CIN) is a serious condition in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. We compared the risk of acute CIN and the influence of preventive strategies in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-A total of 720 patients were randomized in the Prevention of Contrast-induced Nephropathy inPatients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (CINSTEMI) trial. Patients were randomly assigned in a 1:1:1:1 ratio to receive hydration with sodium chloride together with 1 of 4 prophylactic regimes (1) N-acetylcysteine (NAC), (2) sodium bicarbonate (NaHCO 3 ) infusion, (3) NAC in combination with NaHCO 3 , or (4) hydration with sodium chloride infusion alone. Patients in cardiogenic shock were excluded. Acute CIN was defined as an increase in serum creatinine concentration >25% from the baseline value within a 3-day period. Overall, CIN occurred in 141 (21.9%) patients. The prevention treatment with NAC, NaHCO 3 , or the combined NAC and NaHCO 3 did not reduce the rate of CIN significantly compared with hydration with intravenous sodium chloride infusion alone (20.1% versus 20.1% versus 20.8% versus 26.5%; P=NS). However, an increase in serum creatinine >25% from the baseline value to 30 day was significantly lower in patients treated with combined NAC and

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Mehran Contrast-Induced Nephropathy Risk Score Predicts Short- and Long-Term Clinical Outcomes in Patients With ST-Elevation–Myocardial Infarction

Abstract: Background-The

Cited by 135 publications

References 39 publications

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Comparative Study of Predictive Value for Different Risk Scores for Predicting Contrast Induced Nephropathy and Short Outcome after Primary Percutaneous Coronary Intervention

Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment–Myocardial Infarction

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