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

Yıl 2018, Cilt: 21 Sayı: 3, 211 - 216, 02.12.2018

Eyüp Avcı , Didar Elif Akgün Onursal Buğra Ahmet Dolapoğlu Aykan Çelik Tuncay Kırış

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

Akut koroner sendrom, mortalite, risk skoru, renal fonksiyon

Kaynakça

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