Coronary Artery Disease
Predictive Value of CHA2DS2-VASC Score for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome

https://doi.org/10.1016/j.amjcard.2016.11.033Get rights and content

The CHA2DS2-VASC score, used for embolic risk stratification in atrial fibrillation (AF), has been reported recently to predict adverse clinical outcomes in patients with acute coronary syndrome (ACS), regardless of having AF. We investigated the correlation between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with ACS who underwent urgent percutaneous coronary intervention (PCI). A total of 1,408 patients were enrolled in the study. The CHA2DS2-VASC score was calculated for each patient. Based on the receiver operating characteristic analysis, the study population was divided into 2 groups: CHA2DS2-VASC score ≤3 group (n = 944) and CHA2DS2-VASC score ≥4 group (n = 464). Patients were then reallocated to 2 groups according to the presence or absence of CIN. CIN was defined as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within 72 hours after PCI. Overall, 159 cases (11.3%) of CIN were diagnosed. Receiver operating characteristic curve analysis revealed good diagnostic value of CHA2DS2-VASC score in predicting CIN (area under the curve 0.769, 95% confidence interval 0.733 to 0.805; p <0.001). When patients with a CHA2DS2-VASC score of ≥4 were compared with those with a CHA2DS2-VASC score of ≤3, patients with high score had a higher frequency of CIN (23.9% vs 5.1%; p <0.001), and multivariate analysis identified the CHA2DS2-VASC score of ≥4 as an independent predictor of CIN. In conclusion, CHA2DS2-VASC score can be used as a new, simple, and reliable tool to predict CIN in patients with ACS who underwent urgent PCI.

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)

Cited by (40)

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    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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