BackgroundContrast-induced nephropathy (CIN) is a common complication of percutaneous coronary intervention (PCI). This study aimed to develop a new risk stratification score that is simpler and more practical than the standard Mehran risk score (MRS) in prediction of CIN after primary PCI in ST-segment elevation myocardial infarction (STEMI) patients.MethodsA prognostic prediction research with clinical risk score development was conducted. All STEMI patients who underwent primary PCI at the Central Chest Institute from June 1, 2017 to June 30, 2018 were included. Multivariable logistic regression analysis was used to identify independent predictors of CIN with a significant P value < 0.05. Logistic coefficients of each predictor were used for score weighting and transformation. Predictive performance was validated and compared between newly-derived risk score and the MRS by non-parametric receiver operating characteristic (ROC) regression.ResultsA total of 217 patients, 43 (19.8%) with CIN and 174 (80.2%) without CIN, were included for score derivation. A total of 13 potential predictors were explored under multivariable logistic regression model and were subsequently eliminated. The new risk score was based on three final predictors which were ejection fraction of less than 40%, triple-vessel disease as findings from angiogram, and the use of intra-aortic balloon pump (IABP). With only three predictor variables, the score predicted the risk of CIN with good discriminative ability (area under the receiver operating characteristic curve (AuROC): 0.83, 95% confidence interval (CI): 0.76 - 0.90) which was higher than that of the MRS (AuROC: 0.78, 95% CI: 0.69 - 0.87). The score was categorized into low-risk (positive predictive value (PPV): 9.9, 95% CI: 5.4 - 14.4) and high-risk (PPV: 56.5, 95% CI: 42.4 - 70.8) groups at the cut-off point of 2.ConclusionsThe newly developed score was proved to have good predictive performance with fewer numbers of predictors and could be practically applied for risk stratification of CIN in STEMI patients who required emergent primary PCI.
Acute kidney injury (AKI) after a coronary intervention is common in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with significant morbidity and mortality. Several scores have been developed to predict post-procedural AKI over the years. However, the AKI definitions have also evolved, which causes the definitions used in the past to be obsolete. We aimed to develop a prediction score for AKI in patients with STEMI requiring emergency primary percutaneous coronary intervention (pPCI). This study was based on a retrospective cohort of Thai patients with STEMI who underwent pPCI at the Central Chest Institute of Thailand from December 2014 to September 2019. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL from baseline within 48 h after pPCI. Logistic regression was used for modeling. A total of 1617 patients were included. Of these, 195 patients had AKI (12.1%). Eight significant predictors were identified: age, baseline creatinine, left ventricular ejection fraction (LVEF) < 40%, multi-vessel pPCI, treated with thrombus aspiration, inserted intra-aortic balloon pump (IABP), pre- and intra-procedural cardiogenic shock, and congestive heart failure. The score showed an area under the receiver operating characteristic curve of 0.78 (95% CI 0.75, 0.82) and was well-calibrated. The pPCI-AKI score showed an acceptable predictive performance and was potentially useful to help interventionists stratify the patients and provide optimal preventive management.
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