Coronary Artery DiseasePredictive Value of CHA2DS2-VASC Score for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome
Section snippets
Methods
From January 2013 to May 2016, we consecutively admitted a total of 1,453 ACS (ST-elevation myocardial infarction [STEMI] and non–ST-elevation ACS [NSTE-ACS]) patients who underwent urgent PCI at our hospital. For diagnose of STEMI, electrocardiographic changes consisting of persistent ST-elevation of at least 0.1 mV in at least 2 contiguous leads or a left bundle branch block, with subsequent Q-wave formation and elevation of serum markers of myocardial necrosis, were required. To diagnose of
Results
A total of 1,408 patients (1,002 men, 71.2%) who underwent PCI were enrolled in our study, and all study participants were followed up until 72 hours. The mean age of our study population was 60.19 ± 13.03 years, and the mean CHA2DS2-VASC score was 2.86 ± 1.57 (range 1 to 8). All patients had ACS; STEMI was the most frequent clinical diagnosis in 883 patients (62.7%), followed by NSTE-ACS in 525 (37.3%). Patients' demographic, clinical, and angiographic characteristics were compared between
Discussion
The present study demonstrated that the CHA2DS2-VASC score ≥4 was independently associated with CIN development in patients with ACS who were treated by urgent PCI. The linear correlation between a high CHA2DS2-VASC score and CIN was maintained for patients with ACS as it was for patients with stable and elective PCI.
CIN, an important complication after PCI, especially in the setting of ACS, is associated with extended length of hospital stays, increased costs, and increased short- and
Disclosures
The authors have no conflicts of interest to disclose.
References (33)
- et al.
Usefulness of the CHA2DS2-VASC score to predict adverse outcomes in patients having percutaneous coronary intervention
Am J Cardiol
(2016) - et al.
Predictive accuracy of CHA2DS2-VASc and HAS-BLED scores in patients without atrial fibrillation undergoing percutaneous coronary intervention and discharged on dual antiplatelet therapy
Int J Cardiol
(2015) - et al.
Usefulness of the CHADS2 score for prognostic stratification of patients with acute myocardial infarction
Am J Cardiol
(2014) - et al.
CHADS2 score predicts risk of contrast-induced nephropathy in stable coronary artery disease patients undergoing percutaneous coronary interventions
J Formos Med Assoc
(2016) - et al.
Universal definition of myocardial infarction
J Am Coll Cardiol
(2007) - et al.
Contrast-induced nephropathy: definition, epidemiology, and patients at risk
Kidney Int Suppl
(2006) - et al.
Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification
Am J Cardiol
(2004) - et al.
Contrast-induced nephropathy in patients undergoing emergency percutaneous coronary intervention for acute coronary syndrome
Am J Cardiol
(2010) - et al.
Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction
Int J Cardiol
(2014) - et al.
Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables
Am J Cardiol
(2005)
Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation
Chest
The ACEF score as predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention
Int J Cardiol
A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation
J Am Coll Cardiol
Comparison of combination therapy of high-dose oral N-acetylcysteine and intravenous sodium bicarbonate hydration with individual therapies in the reduction of Contrast-induced Nephropathy during Cardiac Catheterisation and Percutaneous Coronary Intervention (CONTRAST): a multi-centre, randomised, controlled trial
Int J Cardiol
Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions
J Am Coll Cardiol
2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association
Eur Heart J
Cited by (40)
Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions
2021, IJC Heart and VasculatureCitation Excerpt :The optimal threshold value of CHA2DS2-VASc score ≥ 2 has sensitivity of 66.7% (53.7% to 78.0%), specificity of 66.7% (62.9% to 70.4%), and AUC of 0.667 [0.596 to 0.737]. However, reported AUCs of CHA2DS2-VASc score in past studies was higher for the patients undergone PCI for ACS 0.81 [0.73–0.90] and 0.769 [0.733–0.805] [18,21]. One plausible cause of such variation can be because our study included exclusively patients undergone primary PCI, which was expected to have more hemodynamically unstable.
Predictive value of oxidant and antioxidant status for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction
2021, Revista Portuguesa de CardiologiaCitation Excerpt :Our results showed that OSI, initial glucose levels, contrast media volume/eGFR ratio, UA and hs-CRP levels were associated with CIN development in patients with STEMI after p-PCI. Previous studies have also shown similar results.26–28 Contrast volume and basal renal insufficiency are important risk factors for CIN29; accordingly, the contrast media volume/eGFR ratio is a good indicator for CIN.28
Impact of the CHA<inf>2</inf>DS<inf>2</inf>-VASc score on late clinical outcomes in patients undergoing left atrial appendage occlusion
2020, International Journal of CardiologyCitation Excerpt :Orvin et al. [15] showed that the CHA2DS2-VASc score predicted 1-year clinical mortality and stroke in patients undergoing TAVI. It has also been proved to be a useful score to predict no-reflow phenomenon or contrast-induced nephropathy in/after percutaneous coronary intervention for acute coronary syndrome [16,17]. In fields other than coronary or structural heart disease interventions, CHA2DS2-VASc score has been used to predict mortality in hospitalized heart failure patients, and it has been associated with ischemic stroke in patients with systemic lupus erythematosus without AF [18,19].
Modified CHA<inf>2</inf>DS<inf>2</inf>-VASc score predicts in-hospital mortality and procedural complications in acute coronary syndrome treated with percutaneous coronary intervention
2020, IJC Heart and VasculatureCitation Excerpt :The impact of CHA2DS2-VASC score on the likelihood of developing acute kidney injury has not been well explored. Kurtul et all described the significant association between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with ACS who underwent emergent PCI [21]. In this study, a significant correlation and a linear relation between modified CHA2DS2-VASc and post PCI acute kidney injury was demonstrated regardless of the kidney injury etiology or the urgency of the intervention.
CHA2DS2-VASc score as a novel predictor for contrast-induced nephropathy after percutaneous coronary intervention in acute coronary syndrome
2019, Indian Heart JournalCitation Excerpt :Other predictors such as low hemoglobin and higher contrast volume were also found significantly correlated with risk of CIN, which are parts of Mehran risk model.10 These findings were concurrent with those of a previous study carried out in 1408 patients with ACS undergoing urgent PCI.13 No correlation could be established with age and gender in this study.
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