Year 2018, Volume 21, Issue 3, Pages 211 - 216 2018-12-02

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

Eyüp Avcı [1] , Didar Elif Akgün [2] , Onursal Buğra [3] , Ahmet Dolapoğlu [4] , Aykan Çelik [5] , Tuncay Kırış [6]

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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.

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.
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Primary Language en
Subjects Medicine
Journal Section Original Investigations
Authors

Author: Eyüp Avcı (Primary Author)

Author: Didar Elif Akgün

Author: Onursal Buğra

Author: Ahmet Dolapoğlu

Author: Aykan Çelik

Author: Tuncay Kırış

Bibtex @research article { khj495062, journal = {Koşuyolu Heart Journal}, issn = {2149-2972}, eissn = {2149-2980}, address = {Kartal Koşuyolu Yüksek İhtisas EAH}, year = {2018}, volume = {21}, pages = {211 - 216}, doi = {}, title = {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}, key = {cite}, author = {Avcı, Eyüp and Akgün, Didar Elif and Buğra, Onursal and Dolapoğlu, Ahmet and Çelik, Aykan and Kırış, Tuncay} }
APA Avcı, E , Akgün, D , Buğra, O , Dolapoğlu, A , Çelik, A , Kırış, T . (2018). 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. Koşuyolu Heart Journal, 21 (3), 211-216. Retrieved from http://dergipark.org.tr/khj/issue/40963/495062
MLA Avcı, E , Akgün, D , Buğra, O , Dolapoğlu, A , Çelik, A , Kırış, T . "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". Koşuyolu Heart Journal 21 (2018): 211-216 <http://dergipark.org.tr/khj/issue/40963/495062>
Chicago Avcı, E , Akgün, D , Buğra, O , Dolapoğlu, A , Çelik, A , Kırış, T . "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". Koşuyolu Heart Journal 21 (2018): 211-216
RIS TY - JOUR T1 - 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 AU - Eyüp Avcı , Didar Elif Akgün , Onursal Buğra , Ahmet Dolapoğlu , Aykan Çelik , Tuncay Kırış Y1 - 2018 PY - 2018 N1 - DO - T2 - Koşuyolu Heart Journal JF - Journal JO - JOR SP - 211 EP - 216 VL - 21 IS - 3 SN - 2149-2972-2149-2980 M3 - UR - Y2 - 2019 ER -
EndNote %0 Koşuyolu Heart Journal 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 %A Eyüp Avcı , Didar Elif Akgün , Onursal Buğra , Ahmet Dolapoğlu , Aykan Çelik , Tuncay Kırış %T 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 %D 2018 %J Koşuyolu Heart Journal %P 2149-2972-2149-2980 %V 21 %N 3 %R %U
ISNAD Avcı, Eyüp , Akgün, Didar Elif , Buğra, Onursal , Dolapoğlu, Ahmet , Çelik, Aykan , Kırış, Tuncay . "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". Koşuyolu Heart Journal 21 / 3 (December 2018): 211-216.