Combined Value of Contrast-Induced Nephropathy and the CHA2DS2-VASc Score for Predicting Mortality in Patients with Acute Coronary Syndrome Who Were Undergoing Percutaneous Coronary Intervention

Abstract

Introduction: Both contrast-induced nephropathy (CIN) and CHA2DS2-VASc score have predictive value for mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), whereas the prognostic significance CHA2DS2-VASc of risk score combined with CIN remains unclear. This study was designed to explore the combined value of CIN and CHA2DS2-VASc score for predicting long-term mortality in these patients.

Patients and Methods: This retrospective study included 1058 consecutive patients with ACS who were treated with PCI. CIN was defined as a serum creatinine increase ≥ 0.5 mg/dL or ≥ 25% within 48-72 hours after contrast exposure. The patients were divided into two groups, as survivors or nonsurvivors.

Results: The CHA2DS2-VASc score and CIN were independently predictive for all-cause mortality (HR: 1.444, 95% CI: 1.327-1.572, p< 0.001; HR: 1.850, 95% CI: 1.298-2.637, p= 0.001, respectively). Also, multivessel diseases, Killip ≥ 2, beta blockers, and ACE/ARB use at follow-up were independently risk factors for all-cause mortality. Adding CIN on top of the CHA2DS2-VASc score yielded superior risk-predictive capacity beyond CHA2DS2-VASc score alone [AUC: 0.735 (0.701-0.769)], which is shown by improved AUC [AUC: 0.754 (0.720-0.787, difference p= 0.0149)] as well as net reclassification improvement (NRI 28.5%, p< 0.001) and integrated discrimination improvement (IDI 0.021, p< 0.001).

Conclusion: Our study demonstrated that combining the predictive value of CIN and the CHA2DS2-VASc score yielded a more accurate predictive value for long-term mortality in ACS patients who underwent PCI as compared to the CHA2DS2-VASc score alone.

Keywords

• Acute coronary syndrome,mortality,risk score,renal function

Perkütan Koroner Girişim Uygulanan Akut Koroner Sendromlu Hastalarda Kontrastla İlişkili Nefropati ve CHA2DS2-VASC Skoru Kombinasyonunun Mortalite için Öngördürücü Değeri

Abstract

Giriş: Kontrast madde nefropatisi (KMN)’nin ve CHA2DS2-VASc skorunun, perkütan koroner girişim (PKG) uygulanan akut koroner sendromlu (AKS) hastalarda mortalite için prediktif değeri vardır; oysaki KMN ile kombine edilmiş olan CHA2DS2-VASc risk skorunun prognostik önemi belirsizliğini korumaktadır. Bu çalışma, bu hastalarda uzun süreli mortaliteyi öngörmek için KMN ve CHA2DS2-VASc skorunun kombine değerini araştırmak üzere tasarlanmıştır.

Hastalar ve Yöntem: Bu retrospektif çalışmada PKG ile tedavi edilen AKS’li 1058 hasta çalışmaya dahil edildi. KMN, kontrast maruziyetinden 48-72 saat sonra serum kreatinin ≥ 0.5 mg/dL veya ≥ %25 artışı olarak tanımlandı. Hastalar sağ kalanlar ve ölenler olmak üzere iki gruba ayrıldı.

Bulgular: CHA2DS2-VASc skoru ve KMN tüm nedenlere bağlı mortalitenin bağımsız  öngördürücüleriydi (HR: 1.444, %95 CI: 1.327-1.572, p< 0.001; HR: 1.850, %95 CI: 1.298-2.637, p= 0.001, sırasıyla). Ayrıca çok damar hastalıkları, killip ≥ 2, beta-bloker ve anjiyotensin dönüştürücü enzim/anjiyotensin reseptör blokerleri (ACE/ARB) kullanımı izlemde tüm nedenlere bağlı mortalite için bağımsız risk faktörleri idi. CHA2DS2-VASc skorunun üstüne KMN eklenmesi, tek başına CHA2DS2-VASc skorunun (AUC: 0.735 (0.701-0.769)) ötesinde üstün risk tahmini kapasitesi sağladı, bu da AUC: 0.754 (0.720-0.787, 0.0149)], net yeniden sınıflandırma iyileştirme (NRI %28.5, p< 0.001) ve entegre ayrımcılık iyileştirmesi (IDI 0.021, p< 0.001) ile gösterildi.

Sonuç: Çalışmamızda, KMN ve CHA2DS2-VASc skoru kombinasyonunun prediktif değerinin, tek başına CHA2DS2-VASc skoruna kıyasla PKG yapılan hastalarda, uzun dönem mortalite için daha doğru bir öngörü değeri sağladığını gösterdik.

Keywords

• Akut koroner sendrom,mortalite,risk skoru,renal fonksiyon

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